{"id":"https://openalex.org/W3096807446","doi":"https://doi.org/10.1182/blood-2020-142968","title":"Investigation of Chest X-Ray Use in the Emergency Department in Pediatric Patients with Sickle Cell Disease Presenting with Fever Compared to Age Matched Controls","display_name":"Investigation of Chest X-Ray Use in the Emergency Department in Pediatric Patients with Sickle Cell Disease Presenting with Fever Compared to Age Matched Controls","publication_year":2020,"publication_date":"2020-11-04","ids":{"openalex":"https://openalex.org/W3096807446","doi":"https://doi.org/10.1182/blood-2020-142968","mag":"3096807446"},"language":"en","primary_location":{"id":"doi:10.1182/blood-2020-142968","doi":"https://doi.org/10.1182/blood-2020-142968","is_oa":false,"landing_page_url":"https://doi.org/10.1182/blood-2020-142968","pdf_url":null,"source":{"id":"https://openalex.org/S200071133","display_name":"Blood","issn_l":"0006-4971","issn":["0006-4971","1528-0020"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Blood","raw_type":"journal-article"},"volume":null,"type":"conference-abstract","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5083996230","display_name":"Urania Dagalakis","orcid":"https://orcid.org/0000-0001-9250-6559","observed_orcids":["https://orcid.org/0000-0001-9250-6559"]},"institutions":[{"id":"https://openalex.org/I126744593","display_name":"University of Maryland, Baltimore","ror":"https://ror.org/04rq5mt64","country_code":"US","type":"education","lineage":["https://openalex.org/I126744593"]},{"id":"https://openalex.org/I1315496137","display_name":"University of Maryland Medical Center","ror":"https://ror.org/00sde4n60","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1315496137","https://openalex.org/I14285509"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Urania Dagalakis","raw_affiliation_strings":["Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD","institution_ids":["https://openalex.org/I126744593","https://openalex.org/I1315496137"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5108962969","display_name":"Henna Butt","orcid":"https://orcid.org/0000-0002-1074-8480","observed_orcids":["https://orcid.org/0000-0002-1074-8480"]},"institutions":[{"id":"https://openalex.org/I126744593","display_name":"University of Maryland, Baltimore","ror":"https://ror.org/04rq5mt64","country_code":"US","type":"education","lineage":["https://openalex.org/I126744593"]},{"id":"https://openalex.org/I1315496137","display_name":"University of Maryland Medical Center","ror":"https://ror.org/00sde4n60","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1315496137","https://openalex.org/I14285509"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Henna Butt","raw_affiliation_strings":["Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD","institution_ids":["https://openalex.org/I126744593","https://openalex.org/I1315496137"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5059414709","display_name":"Natalie Louise Davis","orcid":"https://orcid.org/0000-0002-5147-4543","observed_orcids":["https://orcid.org/0000-0002-5147-4543"]},"institutions":[{"id":"https://openalex.org/I126744593","display_name":"University of Maryland, Baltimore","ror":"https://ror.org/04rq5mt64","country_code":"US","type":"education","lineage":["https://openalex.org/I126744593"]},{"id":"https://openalex.org/I1315496137","display_name":"University of Maryland Medical Center","ror":"https://ror.org/00sde4n60","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1315496137","https://openalex.org/I14285509"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Natalie Davis","raw_affiliation_strings":["Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD","Division of Neonatology, University of Maryland, Baltimore, MD"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD","institution_ids":["https://openalex.org/I126744593","https://openalex.org/I1315496137"]},{"raw_affiliation_string":"Division of Neonatology, University of Maryland, Baltimore, MD","institution_ids":["https://openalex.org/I126744593"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5088004304","display_name":"Regina A. Macatangay","orcid":"https://orcid.org/0000-0002-3868-3287","observed_orcids":["https://orcid.org/0000-0002-3868-3287"]},"institutions":[{"id":"https://openalex.org/I126744593","display_name":"University of Maryland, Baltimore","ror":"https://ror.org/04rq5mt64","country_code":"US","type":"education","lineage":["https://openalex.org/I126744593"]},{"id":"https://openalex.org/I1315496137","display_name":"University of Maryland Medical Center","ror":"https://ror.org/00sde4n60","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1315496137","https://openalex.org/I14285509"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Regina A. Macatangay","raw_affiliation_strings":["Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD","Division of Pediatric Hematology/Oncology, University of Maryland, Baltimore, MD"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Pediatrics, University of Maryland Children's Hospital, Baltimore, MD","institution_ids":["https://openalex.org/I126744593","https://openalex.org/I1315496137"]},{"raw_affiliation_string":"Division of Pediatric Hematology/Oncology, University of Maryland, Baltimore, MD","institution_ids":["https://openalex.org/I126744593"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":5500,"currency":"USD","value_usd":5500},"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":2,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":"136","issue":"Supplement 1","first_page":"26","last_page":"26"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10554","display_name":"Hemoglobinopathies and Related Disorders","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10554","display_name":"Hemoglobinopathies and Related Disorders","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10285","display_name":"Venous Thromboembolism Diagnosis and Management","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2724","display_name":"Internal Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12845","display_name":"Methemoglobinemia and Tumor Lysis Syndrome","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/sickle-cell-disease","display_name":"sickle cell disease","score":0.9990000128746033},{"id":"https://openalex.org/keywords/acute-chest-syndrome","display_name":"acute chest syndrome","score":0.9990000128746033},{"id":"https://openalex.org/keywords/pediatric-emergency-department","display_name":"pediatric emergency department","score":0.8379999995231628},{"id":"https://openalex.org/keywords/fever","display_name":"fever","score":0.8669999837875366},{"id":"https://openalex.org/keywords/febrile-episodes","display_name":"febrile episodes","score":0.6549999713897705},{"id":"https://openalex.org/keywords/clinical-predictors","display_name":"clinical predictors","score":0.515999972820282},{"id":"https://openalex.org/keywords/diagnostic-algorithm","display_name":"diagnostic algorithm","score":0.9490000009536743},{"id":"https://openalex.org/keywords/radiation-exposure","display_name":"radiation exposure","score":0.8399999737739563},{"id":"https://openalex.org/keywords/hydroxyurea","display_name":"hydroxyurea","score":0.6690000295639038},{"id":"https://openalex.org/keywords/folic-acid-supplementation","display_name":"folic acid supplementation","score":0.6740000247955322},{"id":"https://openalex.org/keywords/asthma-comorbidity","display_name":"asthma comorbidity","score":0.7419999837875366},{"id":"https://openalex.org/keywords/health-care-costs","display_name":"health care costs","score":0.4819999933242798},{"id":"https://openalex.org/keywords/unnecessary-testing","display_name":"unnecessary testing","score":0.4189999997615814},{"id":"https://openalex.org/keywords/hospitalization","display_name":"hospitalization","score":0.3400000035762787}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8811840415000916},{"id":"https://openalex.org/C2780976302","wikidata":"https://www.wikidata.org/wiki/Q4677915","display_name":"Acute chest syndrome","level":4,"score":0.876863956451416},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.7820770740509033},{"id":"https://openalex.org/C2778704086","wikidata":"https://www.wikidata.org/wiki/Q693058","display_name":"Chest pain","level":2,"score":0.52444988489151},{"id":"https://openalex.org/C61511704","wikidata":"https://www.wikidata.org/wiki/Q1671857","display_name":"Incidence (geometry)","level":2,"score":0.5144007802009583},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.5038761496543884},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.467363566160202},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.45991602540016174},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.4530108869075775},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.4448516070842743},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.4420594274997711},{"id":"https://openalex.org/C45827449","wikidata":"https://www.wikidata.org/wiki/Q5270338","display_name":"Diagnosis code","level":3,"score":0.4104052484035492},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.3621969223022461},{"id":"https://openalex.org/C2778620579","wikidata":"https://www.wikidata.org/wiki/Q185034","display_name":"Sickle cell anemia","level":3,"score":0.34285682439804077},{"id":"https://openalex.org/C120665830","wikidata":"https://www.wikidata.org/wiki/Q14620","display_name":"Optics","level":1,"score":0.0},{"id":"https://openalex.org/C121332964","wikidata":"https://www.wikidata.org/wiki/Q413","display_name":"Physics","level":0,"score":0.0},{"id":"https://openalex.org/C118552586","wikidata":"https://www.wikidata.org/wiki/Q7867","display_name":"Psychiatry","level":1,"score":0.0},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.0}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1182/blood-2020-142968","doi":"https://doi.org/10.1182/blood-2020-142968","is_oa":false,"landing_page_url":"https://doi.org/10.1182/blood-2020-142968","pdf_url":null,"source":{"id":"https://openalex.org/S200071133","display_name":"Blood","issn_l":"0006-4971","issn":["0006-4971","1528-0020"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Blood","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":1.0}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W7161052072","https://openalex.org/W2460711776","https://openalex.org/W4405365683","https://openalex.org/W2590248585","https://openalex.org/W2567584846","https://openalex.org/W940430663","https://openalex.org/W2100111714","https://openalex.org/W7131834994","https://openalex.org/W3200225711","https://openalex.org/W2070520701"],"abstract_inverted_index":{"Background":[0],"In":[1,280,512],"sickle":[2],"cell":[3,386],"disease":[4,22],"(SCD),":[5],"acute":[6],"chest":[7,52,84,365,420,426,454,481,577,643,669],"syndrome":[8],"(ACS)":[9],"is":[10,68,563],"associated":[11,397],"with":[12,38,48,121,160,162,205,260,264,333,343,356,364,398,453,466,480,494,520,609],"prolonged":[13],"hospitalization,":[14],"increased":[15],"risk":[16,80],"of":[17,50,57,81,99,106,133,157,173,214,238,276,325,338,340,347,382,392,416,434,448,461,475,487,500,559,590,594,638,652,661,668,678,689],"respiratory":[18,527],"failure,":[19],"future":[20],"lung":[21],"and":[23,54,94,293,305,370,373,390,408,422,492,525,580,615,632,642,671],"25%":[24,261],"mortality":[25],"in":[26,114,135,138,601,619],"hospitalized":[27],"patients(Bakshi,":[28],"&":[29],"Krishnamurti,":[30],"2017;":[31],"Vinchinsky":[32],"et":[33,566],"al.":[34,567],"1997).":[35],"Pediatric":[36,44],"patients":[37,76,116,286,326,452,518,597],"SCD":[39,115,161,250],"frequently":[40,88],"present":[41,363],"to":[42,65,73,103,118,128,140,170,194,208,234,254,311,328,362,377,451,464,506,547,585,587,691],"the":[43,171,195,303,329,412,485,498,557,602,620,634,664,676,681],"Emergency":[45],"Department":[46],"(PED)":[47],"complaints":[49],"fever,":[51,521],"pain,":[53,578],"cough,":[55],"all":[56],"which":[58,75,90],"may":[59,61,624,673],"or":[60,122,221,320,666],"not":[62,395,555],"be":[63,531,544],"related":[64],"ACS.":[66,591,662],"It":[67],"challenging":[69],"for":[70,145,406,630],"PED":[71,120,146,175,256,330],"providers":[72],"determine":[74],"are":[77,87,649],"at":[78],"highest":[79],"ACS,":[82,513,610],"so":[83,550],"X-Rays":[85],"(CXR)":[86],"ordered":[89],"increases":[91],"radiation":[92,616],"exposure":[93,617],"healthcare":[95],"costs.":[96],"The":[97],"objective":[98],"this":[100,136],"study":[101],"was":[102,127,150,217],"identify":[104,129,235],"incidence":[105],"CXR":[107,271,553,600,679],"performance,":[108],"as":[109,111,197,199,225,534,536,576],"well":[110,198,535],"ACS":[112,134,206,239,334,357,399,417,435,449,462,476,488,501,560,639],"diagnosis,":[113,411],"presenting":[117,263,327,342,349,519],"our":[119,255,281,595],"without":[123,350,425,457,508],"fever.":[124,265,351],"Our":[125,569],"goal":[126],"significant":[130,236,300,414,650],"clinical":[131,564,573],"predictors":[132,237,415,637,651],"population":[137,622],"order":[139],"implement":[141],"a":[142,229,270,379,538,551,588,599],"diagnostic":[143],"algorithm":[144],"providers.":[147],"Methods":[148],"This":[149],"an":[151,429,471],"IRB-approved":[152],"retrospective":[153],"medical":[154],"record":[155],"review":[156],"subjects":[158,186,251,278,307,353,656],"diagnosed":[159,204,332,355,608],"inclusion":[163,258],"criteria:":[164],"ages":[165],"2-12":[166],"years,":[167],"who":[168,187,201,210,252],"presented":[169,253],"University":[172],"Maryland":[174],"between":[176,185,302],"2016-2018.":[177],"We":[178,227,247],"performed":[179,218,228,242],"bivariate":[180],"analyses":[181],"comparing":[182],"these":[183,509,647],"variables":[184,216],"were":[188,202,211,298,331,358,374,394,419,582,606,640],"febrile":[189,282,291,304,596,621],"vs.":[190,274,345],"afebrile":[191,277,306],"on":[192,272,680],"presentation":[193,273],"PED,":[196,603],"those":[200,209,341,348,465,479,493,507],"ultimately":[203,354,607],"compared":[207,450,463,505,546],"not.":[212],"Analysis":[213],"categorical":[215],"using":[219,243],"Chi-square":[220],"Fischer":[222],"exact":[223],"test":[224],"appropriate.":[226],"multivariable":[230,402],"logistic":[231],"regression":[232],"model":[233],"diagnosis.":[240,400,477],"Analyses":[241],"SAS":[244],"9.4.":[245],"Results":[246],"identified":[248],"424":[249],"meeting":[257],"criteria,":[259],"(n=108)":[262],"Of":[266],"these,":[267],"69%":[268,593],"received":[269,295,598],"42%":[275],"(p=<0.0001).":[279],"group":[283],"21%":[284],"(n=23)":[285],"had":[287,428,444,459,483,496,657],"more":[288,360,375,613],"than":[289,623],"2":[290],"episodes":[292],"100%":[294],"CXRs.":[296],"There":[297],"no":[299],"differences":[301],"when":[308,404,654],"it":[309],"came":[310],"sex,":[312],"asthma":[313,383,410],"diagnosis/comorbidity,":[314],"hydroxyurea":[315],"use,":[316],"folic":[317],"acid":[318],"supplementation,":[319],"pneumococcal":[321],"prophylaxis.":[322],"Overall,":[323],"10%":[324],"(n=42),":[335],"made":[336],"up":[337],"13%":[339,605],"fever":[344,407,631],"9%":[346],"Those":[352],"significantly":[359,396,658],"likely":[361,376,584],"pain":[366,421,427,482,670],"(p=0.003),":[367],"tachypnea":[368,579],"(p=0.001),":[369],"hypoxia":[371,458,467,495,581,641,672],"(p<0.0001),":[372],"have":[378,625],"past":[380],"history":[381,391],"(p=0.0085).":[384],"Sickle":[385],"variant,":[387],"home":[388],"medications,":[389],"splenectomy":[393],"Upon":[401],"modeling,":[403],"adjusting":[405,629],"pre-existing":[409],"only":[413,604],"diagnosis":[418,436,489,502,558,589],"hypoxia.":[423],"Patients":[424,456],"odds":[430,447,474,486,499,660],"ratio":[431],"(OR)":[432],"=0.3":[433],"[95%":[437],"Confidence":[438],"Interval,":[439],"CI":[440],"0.14-0.67],":[441],"indicating":[442,470,611],"they":[443],"70%":[445],"lower":[446],"paint.":[455],"OR=0.12":[460],"[CI":[468,490,503],"0.06-0.25],":[469],"88%":[472],"reduced":[473],"Conversely,":[478],"3.3x":[484],"1.5-7.4]":[491],"8.4x":[497],"4-17.9]":[504],"symptoms.":[510],"Conclusion":[511],"current":[514],"guidelines":[515],"recommend":[516],"that":[517,572,612],"hypoxia,":[522],"tachypnea,":[523],"tachycardia":[524],"abnormal":[526],"exam":[528],"findings":[529,574,648],"should":[530],"treated":[532],"empirically":[533],"receive":[537],"CXR.":[539],"However":[540],"radiological":[541],"signs":[542,549],"can":[543],"delayed":[545],"physical":[548],"normal":[552],"does":[554],"preclude":[556],"if":[561],"there":[562],"suspicion(Howard":[565],"2015).":[568],"data":[570],"demonstrate":[571],"such":[575],"most":[583,635],"correlate":[586],"While":[592],"CXRs":[614],"occurred":[618],"been":[626],"necessary.":[627],"When":[628,645],"asthma,":[633],"notable":[636],"pain.":[644],"present,":[646],"ACS;":[653],"absent,":[655],"decreased":[659],"Incorporating":[663],"presence":[665],"absence":[667],"help":[674],"focus":[675],"use":[677],"appropriate":[682],"patient":[683],"population.":[684],"Disclosures":[685],"No":[686],"relevant":[687],"conflicts":[688],"interest":[690],"declare.":[692]},"counts_by_year":[{"year":2026,"cited_by_count":1},{"year":2025,"cited_by_count":1}],"updated_date":"2026-10-12T09:40:04.860316","created_date":"2020-11-09T00:00:00"}