title: Which Febrile Children With Sickle Cell Disease Need a Chest X-Ray?
abstract: Controversy exists regarding which febrile children with sickle cell disease (SCD) should receive a chest x-ray (CXR). Our goal is to provide data informing the decision of which febrile children with SCD presenting to the emergency department (ED) require a CXR to evaluate for acute chest syndrome (ACS).
  
  
  
  Retrospective chart review of children ages 3 months to 21 years with SCD presenting to the ED at one of two academic children's hospitals with fever ≥38.5°C between January 1, 2010, and December 31, 2012. Demographic characteristics, respiratory symptoms, and laboratory results were abstracted. The primary outcome was the presence of ACS. Binary recursive partitioning was performed to determine predictive factors for a diagnosis of ACS.
  
  
  
  A total of 185 (10%) of 1,837 febrile ED visits met ACS criteria. The current National Heart, Lung, and Blood Institute (NHLBI) consensus criteria for obtaining a CXR (shortness of breath, tachypnea, cough, or rales) identified 158 (85%) of ACS cases, while avoiding 825 CXRs. Obtaining a CXR in children with NHLBI criteria or chest pain and in children without those symptoms but with a white blood cell (WBC) count ≥18.75 × 109/L or a history of ACS identified 181 (98%), while avoiding 430 CXRs.
  
  
  
  Children with SCD presenting to the ED with fever and shortness of breath, tachypnea, cough, rales, or chest pain should receive a CXR due to high ACS rates. A higher WBC count or history of ACS in a child without one of those symptoms may suggest the need for a CXR. Prospective validation of these criteria is needed.
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Katherine
authors.initials: K
authors.lastname: Eisenbrown
authors.affiliation: Pediatric Emergency Medicine and the Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Mark
authors.initials: M
authors.lastname: Nimmer
authors.affiliation: Pediatrics, Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Ellison
authors.affiliation: Children's Research Institute, Children's Hospital of Wisconsin, and Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.affiliation: Pediatric Emergency Medicine and the Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
mesh_terms: D056586:Acute Chest Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology*; D000755:Anemia, Sickle Cell / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000209:etiology*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity