Abstract
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 10years in both an inpatient and emergency department setting. From a total of 915 first CXRs, only 28·2% of CXRs (n=258) had clinically significant findings that altered management or final diagnosis. Of these abnormalities, consolidation represented 52·3%, effusion 8·9%, cardiomegaly 8·4% and sickle cell-related bone changes 6·3%. Indications for CXR of respiratory distress (OR=3·74, 95% CI 2·28-6·13), hypoxia (OR=1·86, 95% CI 1·50-2·31) and cough (OR=1·64, 95% CI 1·33-2·02), were more likely to have significant CXR findings. Patients who had higher peak fever (38·4°C vs. 37·4°C, P=0·001), higher peak CRP (156·4 vs. 46·1, P<0·001) and higher WCC (20·2 vs. 13·6, P<0·001) were more likely to have clinically significant abnormalities on CXR. We found a decision tool using either hypoxia, cough, respiratory distress, T>38°C, CRP>50 or WCC>15×109 /l as indications for CXR, to have a sensitivity of 88% (with 95% CI 0·78-0·95) and specificity of 46% (95% CI 0·43-0·50) for clinically significant findings.
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