• Narmeen I Khan, Keli D Coleman, Mark Nimmer, Ruta Brazauskas, and David C Brousseau.
• Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin, United States. Electronic address: nikhan@mcw.edu.
• Am J Emerg Med. 2024 Dec 13; 89: 757775-77.

BackgroundThe National Heart, Lung, and Blood Institute (NHLBI) defines acute chest syndrome (ACS) as a new infiltrate on chest x-ray (CXR) and at least 1 of the following: fever (≥38.50C), hypoxia, or respiratory symptoms. NHLBI expert consensus recommends a CXR in patients with sickle cell disease (SCD) who have fever and respiratory symptoms. Past work has shown that physicians fail to recognize ACS in children with SCD who present with fever, leading to varied CXR obtainment criteria.PurposeTo determine the prevalence of ACS in patients with SCD presenting to our ED with fever with or without respiratory symptoms.MethodsA retrospective analysis of ED visits by patients with SCD (ages 0 to 20 years) who presented with fever (>/= 38.5o C) within the past 24 h between January 2019 to December 2022 was done. The presence or absence of NHLBI-defined respiratory symptoms and CXR results were extracted. The prevalence of ACS, demonstrated on CXR, for febrile children with and without respiratory symptoms was estimated.ResultsThere were 137 children (288 unique ED visits) with fever. We found 0 % of visits with fever and no respiratory symptoms had ACS whereas 22.6 % with at least 1 respiratory symptom (p < 0.001).ConclusionsOur findings provide strong evidence that a CXR is not necessary in a child with SCD presenting to the ED with fever and no NHLBI-defined respiratory symptoms. This evidence could improve quality of care and decrease unnecessary CXR use in the SCD population.Published by Elsevier Inc.

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