title: Accuracy of Point-of-care Lung Ultrasonography for Diagnosis of Acute Chest Syndrome in Pediatric Patients with Sickle Cell Disease and Fever.
abstract: The objective was to determine the test performance characteristics for point-of-care lung ultrasonography (LUS) performed by pediatric emergency medicine (PEM) physicians compared with radiographic diagnosis of acute chest syndrome (ACS) in patients with sickle cell disease (SCD) and fever.
  
  
  
  This was a prospective study of patients up to 21 years with SCD and fever requiring chest X-ray (CXR) evaluation for ACS. Before obtaining CXR, a blinded PEM physician performed LUS using a standardized scanning protocol. Positive LUS for ACS was defined as lung consolidation. All patients received CXR and follow-up. The criterion standard for ACS was consolidation on CXR as determined by a blinded radiologist. LUS clips were reviewed by a blinded expert PEM sonologist.
  
  
  
  A total of 116 febrile events from 91 patients with a median age of 5.7 years were enrolled by 15 PEM sonologists. CXR was positive for ACS in 15 (13%) patients, and LUS was positive for ACS in 19 (16%) patients. Positive LUS had a sensitivity of 87% (95% confidence interval [CI] = 62% to 96%), specificity of 94% (95% CI = 88% to 97%), positive likelihood ratio of 14.6 (95% CI = 6.5 to 32.5), and negative likelihood ratio of 0.14 (95% CI = 0.04 to 0.52) for ACS. The interobserver agreement (kappa) was 0.77. There were two missed cases of ACS on LUS.
  
  
  
  LUS may be sensitive and specific for diagnosis of ACS in pediatric patients with SCD and fever. LUS may reduce the need for routine CXR and associated ionizing radiation exposure in this population.
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Dina D
authors.initials: DD
authors.lastname: Daswani
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of New Jersey, Newark Beth Israel Medical Center, Newark, NJ.
authors.forename: Vaishali P
authors.initials: VP
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Avner
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology & Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Deepa G
authors.initials: DG
authors.lastname: Manwani
authors.affiliation: Department of Radiology, Division of Pediatric Radiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kurian
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Joni E
authors.initials: JE
authors.lastname: Rabiner
mesh_terms: D056586:Acute Chest Syndrome / Q000000981:diagnostic imaging*; D000755:Anemia, Sickle Cell; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D011014:Pneumonia; D019095:Point-of-Care Systems; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000592:standards*