Plain film x-rays in the diagnosis of sickle cell limb pain in children
PDF

Keywords

Sickle Cell disease
Veno-occlusive crisis
Limb pain
X-ray

How to Cite

Vivian, F., & Chakravorty, S. (2021). Plain film x-rays in the diagnosis of sickle cell limb pain in children: A 10-year retrospective audit in a tertiary sickle cell centre. The Physician, 7(1), 1-6. https://doi.org/10.38192/1.7.1.4

Abstract

Background and aims: Children with sickle cell disease (SCD) frequently present with limb pain. Differentials include vaso-occlusive episode (VOE) and osteomyelitis (OM). X-rays expose to radiation but rarely aid in diagnosis. We audited the use of x-ray in investigating children with SCD presenting with limb pain to a South London hospital and analysed whether x-rays aid in diagnosis.

Methods: Patients aged 0-18 with SCD were identified using the hospital’s SCD database. Admissions from January 2010 to September 2019 in which limb pain was a documented symptom were included.

Results: Of 342 patients investigated, there were 188 admissions with limb pain. Diagnoses at discharge were: 174 VOE, 4 OM, and 7 others. 44 (25%) of those with VOE had limb x-rays, compared with 3 (75%) of those with OM. Of those x-rayed, 11 with VOE and all with OM had a subsequent MRI. None of the x-rays assisted in confirming the diagnosis or change management. Of the VOE patients, more of those that were x-rayed had swelling (48% vs 8%, p=<0.0001), and fevers (57% vs 37%, p=0.021), and peak CRP was higher (109 vs 75, p=0.044).

Conclusions: X-rays were frequently used to investigate children with SCD. Limb swelling, fevers and higher CRP, features potentially suggestive of OM, were more common in those that were x-rayed. X-rays did not aid in distinguishing VOE and OM or change management.

https://doi.org/10.38192/1.7.1.4
PDF

References

Dormandy, E., James, J., Inusa, B. & Rees, D. How many people have sickle cell disease in the UK? J Public Health (Oxf) 40, e291-e295, doi:10.1093/pubmed/fdx172 (2018).

Platt, O. S. et al. Pain in sickle cell disease. Rates and risk factors. N Engl J Med 325, 11-16, doi:10.1056/NEJM199107043250103 (1991).

Kosaraju, V. et al. Imaging of musculoskeletal manifestations in sickle cell disease patients. Br J Radiol 90, 20160130, doi:10.1259/bjr.20160130 (2017).

Burnett, M. W., Bass, J. W. & Cook, B. A. Etiology of osteomyelitis complicating sickle cell disease. Pediatrics 101, 296-297 (1998).

Al Farii, H., Zhou, S. & Albers, A. Management of Osteomyelitis in Sickle Cell Disease: Review Article. J Am Acad Orthop Surg Glob Res Rev 4, e2000002-2000010, doi:10.5435/JAAOSGlobal-D-20-00002 (2020).

Vanderhave, K. L., Perkins, C. A., Scannell, B. & Brighton, B. K. Orthopaedic Manifestations of Sickle Cell Disease. J Am Acad Orthop Surg 26, 94-101, doi:10.5435/JAAOS-D-16-00255 (2018).

Kleinerman, R. A. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 36 Suppl 2, 121-125, doi:10.1007/s00247-006-0191-5 (2006).

Fontalis, A. et al. The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review. J Child Orthop 13, 33-39, doi:10.1302/1863-2548.12.180094 (2019).

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2021 Array