Research Article| May 01 2018 Risk Factors for Development of Acute Chest Syndrome AAP Grand Rounds (2018) 39 (5): 59. https://doi.org/10.1542/gr.39-5-59 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Risk Factors for Development of Acute Chest Syndrome. AAP Grand Rounds May 2018; 39 (5): 59. https://doi.org/10.1542/gr.39-5-59 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: acute chest syndrome, sickle cell anemia, asthma Source: Takahashi T, Okubo Y, Handa A. Acute chest syndrome among children hospitalized with vaso-occlusive crisis: a nationwide study in the United States. Pediatr Blood Cancer. 2018; 65(3): e26885; doi: https://doi.org/10.1002/pbc.26885Google Scholar Investigators at multiple institutions conducted a cross-sectional study of children with sickle cell disease hospitalized with a vaso-occlusive crisis (VOC) to assess trends in hospital utilization and factors associated with development of acute chest syndrome (ACS). Data for this study were obtained from the Kids’ Inpatient Database (KID), a large, all-payer US hospital pediatric discharge database. Hospital discharge records in KID of patients ≤19 years old with VOC from years 2003, 2006, 2009, and 2012 were analyzed. Patient demographics, clinical features (eg, presence of comorbid obesity, asthma or obstructive sleep apnea [OSA]), and hospital characteristics (eg, hospital type [urban teaching, urban non-teaching, rural]) were obtained from KID. The primary outcomes were total hospitalization charge, length of stay (LOS) in days, and in-hospital mortality. A secondary outcome was development of ACS, identified using diagnosis fields in KID. Investigators used multivariable linear regression to assess for trends in hospital charges, LOS, and mortality from 2003–2012. Multivariable logistic regression was used to assess the demographic and clinical characteristics associated with ACS. There were 22,511 hospital discharges identified in 2003; 23,196 in 2006; 21,776 in 2009; and 24,292 in 2012. Most discharges in each year involved children who were 15–19 years old, black, and had public insurance. Most were discharged from urban teaching hospitals. The mean hospitalization charge significantly increased from $13,958 in 2003 to $25,512 in 2012 (P < .001). The mean LOS significantly decreased from 4.66 days in 2003 to 4.23 days in 2012 (P < .001). There was no change in mortality. The risk factors associated with development of ACS included younger age, male gender, comorbid asthma, and comorbid OSA. The authors conclude that several factors are associated with development of ACS in children hospitalized with VOC. Dr Hogan has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. ACS refers to any respiratory symptoms in an individual with sickle cell disease associated with a new pulmonary infiltrate on radiograph. 1 Since imaging may lag behind clinical signs, surveillance and intervention are required for evolving tachypnea, hypoxia, rales, or decreased breath sounds with or without fever.2 The pathogenesis of ACS involves vaso-occlusion, endothelial adhesion, thrombosis, hypoxemia, and hemolysis stemming from and/or leading to pulmonary infection, fat embolism, infarction, and hypoventilation. ACS is the second most common cause of hospitalization in children with sickle cell disease, behind VOC, and has a variable mortality rate. Recurrent ACS can lead to persistent lung disease, thereby worsening other comorbidities.1 Previously identified risk factors for children hospitalized for ACS include age <4 years, low hemoglobin (Hb) F, high baseline white blood cell count, >3 significant VOC episodes in the past year, asthma, tobacco smoke exposure,... You do not currently have access to this content.