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

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Abstract
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 P < 0.05], diastolic BP at 48 hr (OR 1.8 per 10 mm increase, PP < 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. Pediatr Blood Cancer 2008;50:1006–1012.
Funding Information
  • NIH (K12RR01627)
  • Doris Duke Charitable Foundation; American Society of Hematology