Elsevier

Annals of Emergency Medicine

Volume 20, Issue 11, November 1991, Pages 1210-1214
Annals of Emergency Medicine

Original contribution
Usefulness of empiric chest radiography and urinalysis testing in adults with acute sickle cell pain crisis

https://doi.org/10.1016/S0196-0644(05)81473-8Get rights and content

Study objective:

To determine the usefulness of obtaining routine chest radiographs and urinalyses on adults presenting to the emergency department in acute sickle cell pain crisis. The hypothesis tested is that in some adult sickle cell patients, sickle cell pain crises are precipitated or accompanied by acute infection that may be clinically occult and that routine screening for pulmonary or urinary tract infection would identify some of these precipitating illnesses.

Design:

Prospective clinical study.

Setting:

A university hospital ED.

Patients:

All patients more than 14 years old with S-S, S-C, or S-β-thalassemia sickle hemoglobinopathies who presented to the ED with acute nontraumatic painful complaints during a six-month period.

Interventions:

All patients underwent posteroanterior and lateral chest radiography, routine urinalysis, and CBC count with reticulocyte count. A standard questionnaire for localizing symptoms of systemic, pulmonary, and urinary tract infection was completed for each patient. Urine cultures were ordered on all patients with voiding symptoms, flank pain, and/or more than 5 WBCs or RBCs per high-power field on urinalysis. Physical examination for evidence of pulmonary and urinary tract infection was carefully performed and recorded for subsequent analysis.

Results:

Seventy-one patients with 134 ED presentations were studied over a six-month period. Eight diagnoses of acute pneumonia were made. Four of these patients complained of chest pain (50% vs 48% overall) and three had shortness of breath (38% vs 21%). None of these patients complained of fever or symptoms of upper respiratory illness. Ten diagnoses of urinary tract infection were made. Four of these patients complained of dysuria and frequency; three complained of flank pain. Eleven of the 18 infections (61.1%) did not have a typical history for or suggestive physical or laboratory findings of bacterial infection.

Conclusion:

In sickle cell disease patients with pain crisis, routine chest radiography and urinalysis may be clinically useful and cost effective in the early diagnosis of crisis-related infection.

References (22)

  • DiggsLW

    Sickle cell crises

    Am J Clin Pathol

    (1965)
  • Cited by (12)

    • Pulmonary complications

      1996, Hematology/Oncology Clinics of North America
    View all citing articles on Scopus

    Presented at the Society for Academic Emergency Medicine Annual Meeting in Washington, DC, May 1991.

    View full text