title: Prodromal illness before acute chest syndrome in pediatric patients with sickle cell disease.
abstract: BACKGROUND
  Acute chest syndrome (ACS) is associated with morbidity and mortality in children with sickle cell disease. We hypothesize that children with sickle cell disease have a distinct prodromal illness before their ACS episode.
  
  
  METHODS
  We performed a chart review of ICD-9-CM identified ACS episodes at a pediatric hospital from 2005 to 2010. Prodromal visits were defined as acute visits that resulted in a discharge from care and occurred within 2 weeks of a hospitalization that included ACS. We reviewed the documented history, examination, laboratory studies, and radiographs for each prodromal visit.
  
  
  RESULTS
  We identified 196 ACS episodes. Children received prodromal care in 29% of the ACS episodes. Painful vaso-occlusive crisis was a common reason for seeking this care (61%) and was commonly located in the chest or back (81%). We also observed that patients were hypoxic (53%), tachypneic (29%), had a history of asthma (39%) or ACS (80%), and presented during the winter months (38%).
  
  
  CONCLUSIONS
  These data suggest that nearly one third of patients who develop ACS seek care for a prodromal illness. Further research is needed to confirm and better define an ACS prodromal illness that may help to identify patients at high risk for developing ACS.
authors.affiliation: *Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH †Division of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Creary
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Krishnamurti
mesh_terms: D056586:Acute Chest Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology*; D000755:Anemia, Sickle Cell / Q000150:complications*; D001249:Asthma / Q000150:complications; D001416:Back Pain / Q000000981:diagnostic imaging / Q000209:etiology; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000209:etiology; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D062706:Prodromal Symptoms; D011859:Radiography; D012189:Retrospective Studies; D059246:Tachypnea / Q000209:etiology