Acute Chest Syndrome: Can a Chest Radiograph Predict the Course Severity of the Disease?

Arie Franco, Kathleen Tarrant McKie, Patrick Ryan Henderson, Kristopher Neal Lewis, Roger Anthony Vega


Background: The severity and predictability of acute chest syndrome (ACS) varies among patients with sickle cell disease.  In our study we analyze whether the pathology identified in the first chest radiograph predict the course severity of ACS.

Methods: We retrospectively reviewed the clinical records and radiographs of 79 episodes of acute chest syndrome in 63 patients with sickle cell disease. We established three categories of severity based on the following parameters: length of admission more than three days, presence of hypoxia, intensive care unit stay, and need for intubation. Two radiologists independently reviewed the first chest radiograph performed on the day of admission. The radiologist graded the degree of pathology and assigned it to one of four levels. Level 1 was defined as complete whiteout of the lungs or consolidation in any lobe with existence of pleural effusion; Level 2 consolidation in 4 lobes; Level consolidation in 3 lobes and level 4 as consolidation in 2 lobes.

Results: We calculated the sensitivity, specificity and receiver-operating curve in all three severity categories. In all categories the area under the curve of the receiver-operating curve was above 0.5, archiving statistical significance.

Conclusion: Patients presenting with multiple lobe involvement in the first chest radiograph had a worse clinical course. These patients might benefit from more aggressive therapy. Our study suggests that predicting the disease severity based on admission chest radiograph may be a useful tool allowing early intervention in the disease course to prevent clinical deterioration and shorten length of stay.



Acute chest syndrome; Sickle cell disease; Chest 

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