What is the role of chest X-ray imaging in the acute management of children with sickle cell disease?

Children with sickle cell disease (SCD) frequently present to hospital acutely unwell and are often exposed to diagnostic chest X-rays (CXRs). Little evidence exists to determine when CXRs are clinically useful. Using electronic hospital records, we audited CXR use in children aged 0-18 who presented to hospital over the past 10 years in both an inpatient and emergency department setting. From a total of 915 first CXRs, only 28 center dot 2% of CXRs (n = 258) had clinically significant findings that altered management or final diagnosis. Of these abnormalities, consolidation represented 52 center dot 3%, effusion 8 center dot 9%, cardiomegaly 8 center dot 4% and sickle cell-related bone changes 6 center dot 3%. Indications for CXR of respiratory distress (OR = 3 center dot 74, 95% CI 2 center dot 28-6 center dot 13), hypoxia (OR = 1 center dot 86, 95% CI 1 center dot 50-2 center dot 31) and cough (OR = 1 center dot 64, 95% CI 1 center dot 33-2 center dot 02), were more likely to have significant CXR findings. Patients who had higher peak fever (38 center dot 4 degrees C vs. 37 center dot 4 degrees C, P = 0 center dot 001), higher peak CRP (156 center dot 4 vs. 46 center dot 1, P < 0 center dot 001) and higher WCC (20 center dot 2 vs. 13 center dot 6, P < 0 center dot 001) were more likely to have clinically significant abnormalities on CXR. We found a decision tool using either hypoxia, cough, respiratory distress, T > 38 degrees C, CRP > 50 or WCC > 15 x 10(9)/l as indications for CXR, to have a sensitivity of 88% (with 95% CI 0 center dot 78-0 center dot 95) and specificity of 46% (95% CI 0 center dot 43-0 center dot 50) for clinically significant findings.