Re‐examining a strong recommendation based on low‐quality evidence in acute chest syndrome

Abstract

Well before use of the term "acute chest syndrome" (ACS) to describe a constellation of findings including radiographic evidence of segmental lung consolidation plus some combination of fever, cough, tachypnea, and chest pain in patients with sickle cell disease (SCD), the severity of pneumonia caused by Mycoplasma pneumoniae in children with SCD was well described. 1 Thirty years later, seminal findings of the National Acute Chest Syndrome Study Group were published. 2 Detailed analyses of 671 episodes of ACS among 538 patients were provided, including many patients who underwent diagnostic bronchoscopy. It was found that fat embolization was a frequent cause of ACS among adults, whereas infection due to Chlamydia pneumoniae or M. pneumoniae was common in children. Further study by the same group using newly emerging diagnostic polymerase chain reaction (PCR) technology detected C. pneumoniae in 14% of patients with ACS. 3