Late Breaking Abstract - Usefulness of lung ultrasound in the diagnosis and early detection of acute chest syndrome in children with sickle cell disease

Abstract

Introduction: Early detection of Acute chest syndrome (ACS) can improve the prognosis of sickle cell disease (SSD. Recommendations for screening remain based on chest X-ray imaging and young patients with SCD are repeatedly exposed to diagnostic radiation. Lung ultrasound (LUS) can detect early lung lesions suggestive of ACS during a vaso-occlusive crisis (VOC). The objective of our study was to define the accuracy of LUS in detecting early lung lesions suggestive of ACS in patients hospitalized for VOC.

Methods: This was a prospective multicentre study conducted on 4 paediatric departments in patients with SCD hospitalized with VOC and aged 1-18 years. The inclusion criteria were children presenting VOE with normal chest x-ray at admission. Clinicians with expertise in point of care LUS performed LUS on admission and on 3 consecutive days and compared it with chest radiographs taken on admission, on the last day or before if the patient had clinical signs suggestive of ACS. Accuracy, sensitivity, specificity, likelihood ratios, and positive and negative predictive value were calculated for the performance characteristics of LUS compared to chest X-ray.

Results: LUS was performed on 121 SCD patients hospitalized for VOC. The prevalence of ACS was 12%, all patients with ACS had consolidations on their LUS and 93% of them on admission or Day 1. The sensitivity of LUS in our cohort was 100% and the specificity 40% compared to chest radiography.

Conclusion: LUS appears to be a useful and feasible tool for the early detection of ACS during hospitalization of SCD patients presenting with a VOCs, compared with chest radiography.