Lung ultrasound score to predict development of acute chest syndrome in children with sickle cell disease

IF 1.8 Q3 HEMATOLOGY

Hematology, Transfusion and Cell Therapy Pub Date : 2024-11-01 DOI:10.1016/j.htct.2024.07.003

Pedro P.M.G. Vieira, Josefina A.P. Braga, Rodrigo Regacini

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Abstract

Objective

This study aims to identify lung ultrasound (LUS) findings associated with acute chest syndrome (ACS) at the time of admission and 24–48 h later, to compare these to chest radiography (CXR) findings and to establish a score to predict the development of this pulmonary complication in sickle cell disease (SCD) children

Methods

A prospective observational study of SCD children presenting signs or symptoms of ACS evaluated by LUS and CXR at admission and 24–48 h later. A score was conceived to predict the evolution of ACS during hospitalization based on ultrasonographic findings.

Results

Seventy-eight children were evaluated; 61 (78.2 %) developed ACS. A score greater than one at admission showed sensitivity, specificity, accuracy, and positive predictive value (PPV) of 75.4 %, 88.2 %, 78.2 %, and 95.8 %, respectively to predict ACS, while only 32 (52.5 %) CXR showed alterations. The development of ACS during hospitalization was unlikely for a score of zero and very likely for a score greater than one at admission. Regarding follow-up exams, a score greater than one showed sensitivity, specificity, accuracy, and PPV of 98.4 %, 76.5 %, 93.6 %, and 92.8 %, respectively to predict the development of ACS. ACS development was very unlikely for a score of zero and very likely for a score greater than zero in the follow-up.

Conclusion

LUS is an effective tool to assess risk for the development of ACS in SCD children with clinical suspicion.

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预测镰状细胞病患儿急性胸部综合征发展的肺部超声波评分。

研究目的本研究旨在确定入院时和 24-48 小时后与急性胸部综合征（ACS）相关的肺部超声波（LUS）检查结果，将这些结果与胸部X光检查（CXR）结果进行比较，并建立预测镰状细胞病（SCD）患儿肺部并发症发展的评分方法：一项前瞻性观察研究，研究对象为入院时和 24-48 小时后出现 ACS 体征或症状的 SCD 患儿，通过 LUS 和 CXR 进行评估。根据超声波检查结果设计了一个评分标准，用于预测住院期间 ACS 的演变情况：结果：78 名儿童接受了评估，其中 61 名（78.2%）患上了 ACS。入院时评分大于 1 分的患儿预测 ACS 的敏感性、特异性、准确性和阳性预测值（PPV）分别为 75.4%、88.2%、78.2% 和 95.8%，而只有 32 名患儿（52.5%）的 CXR 出现了变化。如果入院时的评分为零，则在住院期间发生 ACS 的可能性不大；如果评分大于 1，则发生 ACS 的可能性很大。在随访检查中，得分大于 1 的患者预测发生 ACS 的敏感性、特异性、准确性和 PPV 分别为 98.4%、76.5%、93.6% 和 92.8%。在随访中，得分为零的患者发生 ACS 的可能性很小，得分大于零的患者发生 ACS 的可能性很大：结论：LUS 是评估临床可疑 SCD 儿童发生 ACS 风险的有效工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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