Bernard et al developed a simple score for evaluating a patient with sickle cell disease in the Emergency Department. The authors are fro the University of Cincinnati and Allegheny General Hospital in Pittsburgh.
Patient selection: sickle cell disease
Outcome: adverse outcome within 96 hours (transfusion, antibiotic therapy, acute chest syndrome, aplastic crisis, sequestration crisis)
Parameters:
(1) sickle hemoglobin type
(2) chest pain
(3) chills
(4) pain
(5) temperature in °C
(6) oxygen saturation in percent
(7) hemoglobin in g/dL
(8) nitrites in urinalysis
(9) chest X-ray
|
Parameters |
Findings |
Points |
|
sickle hemoglobin |
sickling variant (SS, SC, other) |
1 |
|
|
non-sickling (sickle-thalassemia, possibly AS) |
0 |
|
|
unknown |
1 |
|
chest pain |
absent |
0 |
|
|
present |
1 |
|
chills |
absent |
0 |
|
|
present |
1 |
|
pain |
absent or similar to previous episodes |
0 |
|
|
not similar to previous episodes |
1 |
|
temperature |
36 to 38°C |
0 |
|
|
< 36 or > 38°C |
1 |
|
oxygen saturation |
>= 95% |
0 |
|
|
< 95% |
1 |
|
hemoglobin |
>= 10 g/dL |
0 |
|
|
< 10 g/dL |
1 |
|
nitrites |
absent |
0 |
|
|
present |
1 |
|
chest X-ray |
normal |
0 |
|
|
abnormal |
1 |
where:
• Nitrites in urinalysis would seem to indicate a urinary tract infection.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• A score > 4 was considered at risk.
Performance:
• A score > 4 had an overall accuracy of 83% with sensitivity of 49% and specificity of 95%
• The positive predictive value (78%) exceeded physician judgment (63%) while the negative predictive value (84%) was not as good as physician judgment (91%).
• The area under the ROC curve was about 0.82.
Purpose: To evaluate a patient with sickle cell disease in the ED using the score of Bernard et al.
Specialty: Hematology Oncology, Clinical Laboratory, Genetics
Objective: risk factors, severity, prognosis, stage, complications
ICD-10: D57,
