Corticosteroids and increased risk of readmission after acute chest syndrome in children with sickle cell disease.

Corticosteroids and increased risk of readmission after acute chest syndrome in children with sickle cell disease. Research Abstract Details 

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Corticosteroids and increased risk of readmission after acute chest syndrome in children with sickle cell disease. Abstract Text:

John J Strouse,Clifford M Takemoto,Jeffrey R Keefer,Gregory J Kato,James F Casella,

BACKGROUND: Acute chest syndrome (ACS) is a frequent cause of hospitalization and mortality in children with sickle cell disease. Transfusion is often required to prevent respiratory failure and treatment with dexamethasone may reduce the length of admission and the need for transfusions. We performed a retrospective cohort study to evaluate risk factors for readmission and prolonged hospitalization after different treatments for ACS. PROCEDURE: We identified patients <22 years of age hospitalized with ACS at Johns Hopkins Hospital from January 1998 to April 2004 using the hospitals discharge database and by reviewing dictated summaries. RESULTS: We identified 65 patients with 129 episodes of ACS (mean age 12.5 years, range 1.2-21.9 years). Thirty-nine episodes were treated with corticosteroids and 51 with transfusions. Patients were readmitted within 14 days after 23 episodes (18%). Readmission was strongly associated with report of an inhaler or nebulizer at home [odds ratio (OR) 6.0, P < 0.05], diastolic BP at 48 hr (OR 1.8 per 10 mm increase, P<0.01), corticosteroids (OR 20, P < 0.005), or transfusion (OR 0.03, P < 0.05). Treatment with corticosteroids alone (P < 0.05) and older age (P < 0.001) were associated with longer hospitalization. CONCLUSIONS: These results demonstrate a greatly elevated independent risk of readmission after ACS in children with asthma and after treatment with corticosteroids and a protective effect of transfusion. Although dexamethasone has documented efficacy for reducing the duration of ACS, the substantial risk of readmission for pain should limit its use.

Corticosteroids and increased risk of readmission after acute chest syndrome in children with sickle cell disease. Publishing Authors By Initials

JJ Strouse,CM Takemoto,JR Keefer,GJ Kato,JF Casella,

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Corticosteroids and increased risk of readmission after acute chest syndrome in children with sickle cell disease. Journal Published:

PUBLICATION TYPE: Research Support, Non-U.S. Gov

Journal: Pediatric blood & cancer

VOLUME: 50

Page Numbers: 1006-12

Journal Abbreviation:

ISSN: 1545-5017

DAY: 2

MONTH: May

YEAR: 2008

Corticosteroids and increased risk of readmission after acute chest syndrome in children with sickle cell disease. Information

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LANGUAGE: eng

NlmUniqueID: 101186624

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Grant and Affiliation Information for Corticosteroids and increased risk of readmission after acute chest syndrome in children with sickle cell disease.

AFFILIATION: Division of Pediatric Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jstrous1@jhmi.edu

Country: United States

AGENCY: United States NCRR

GRANT: K12RR01627

ACRONYM: RR

MEDLINETA: Pediatr Blood Cancer

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