Protocol - Acute Chest Syndrome - Pregnancy

Description

This protocol includes 22 items that can be completed via medical record abstraction to capture details of acute chest syndrome (ACS) during pregnancy. Items capture whether ACS required hospitalization, admission to an intensive care unit, and blood transfusion; the gestational age of ACS; the clinical features that were present (e.g., chest pain, temperature); and whether a diagnosis of ACS was made.

Specific Instructions

The Sickle Cell Disease Pregnancy Working Group (WG) notes that the protocol below can be used in both high-resource and low-resource settings. They further suggest that these additional details may also be included: concurrent cardiac, kidney, neurologic, or hepatic complications, as well as acute thrombocytopenia with percentage decline in platelet count.

The WG recommends that investigators review Acute Chest Syndrome - General Populations in the PhenX Supplemental Information.

Availability

Available

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Protocol

Acute Chest Syndrome During Pregnancy With Sickle Cell Disease

Past Medical History
1. Acute chest syndrome		[ ] Yes	[ ] No
1a. If yes: Hospitalization		[ ] Yes	[ ] No
1b. If yes: ICU admission		[ ] Yes	[ ] No
Previous Pregnancy
2. ACS requiring hospitalization		[ ] Yes	[ ] No
2a. If yes: simple transfusion		[ ] Yes	[ ] No
2b. If yes: exchange transfusion		[ ] Yes	[ ] No
Current Pregnancy
3. Hyperhemolysis		[ ] Yes	[ ] No
4. Pneumonia (choose only in absence of ACS; if features of ACS, choose ACS ) instead		[ ] Yes	[ ] No
5. Acute chest syndrome		[ ] Yes	[ ] No
5a. If yes: # of distinct ACS episodes during current study pregnancy		_____ number
5b. If yes: GA at 1st event Gestational age in weeks with days as decimal point 12 1/7 = 12.1 12 2/7 = 12.3 12 3/7 = 12.4 12 4/7 = 12.6 12 5/7 = 12.7 12 6/7 = 12.9		_____ week.days
5c. If yes: ICU admission		[ ] Yes	[ ] No
5d. If yes: ACS during current study pregnancy requiring hospitalization (but not ICU care)		[ ] Yes	[ ] No
What clinical features of ACS were present?	Present	Absent	Unknown
5e. Chest Pain	[ ]	[ ]	[ ]
5f. Positive Auscultatory Chest signs	[ ]	[ ]	[ ]
5g. Fever (Temp > 38oC)	[ ]	[ ]	[ ]
5h. Signs of respiratory distress (RR > 20 per minute)	[ ]	[ ]	[ ]
5i . Increase in oxygen requirement/demand	[ ]	[ ]	[ ]
5j. SpO2: < 94% OR drop by 3% below baseline	[ ]	[ ]	[ ]
5k. New radiodensity on chest x-ray (CXR)	[ ]	[ ]	[ ]
Acute Chest Syndrome Diagnosis – The below section should be filled out for all hospitalizations
6. Was the criteria for diagnosis of acute chest syndrome fulfilled? Criteria for Acute Chest Syndrome: Abnormal finding on lung examination [grunting, flaring, retractions (intercostal, subcostal), audible wheezing without auscultation with stethoscope, difficulty breathing based on visually inspection, pulmonary auscultatory findings] typically evaluated without oxygen supplementation, if possible, with thepresence of at least two of the following criteria: Temperature greater than or equal to 38ºC. Increased respiratory rate greater than the 90th percentile for age. Positive chest pain or pulmonary auscultatory findings increased oxygen requirement (saturation of peripheral oxygen drop by > 3% from a documented steady-state value on room air). New radiodensity on chest roentgenogram.			[ ] Yes [ ] No
7. Did the inpatient care team diagnose acute chest syndrome during hospitalization?			[ ] Yes [ ] No

Personnel and Training Required

Personnel should be trained in medical record abstraction.

Equipment Needs

None

Requirements

Requirement Category	Required
Major equipment	No
Specialized training	No
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Medical record abstraction

Lifestage

Adolescent, Adult

Participants

Pregnant women with sickle cell disease

Selection Rationale

These questions from Malinowski et al. (2021) and Sickle Cell Disease Obstetric Multi-Disciplinary Care Programme were selected as the best way to capture the details around acute chest syndrome (ACS) episodes and whether clinical features supported a diagnosis of ACS.

Language

English

Standards

Standard	Name	ID	Source

Derived Variables

None

Process and Review

Protocol Name from Source

Malinowski AK, et al. Distinct maternal and fetal pregnancy outcomes in women with sickle cell disease can be predicted using routine clinical and laboratory data. Br J Haematol. 2021

Sickle Cell Disease Obstetric Multi-Disciplinary Care Programme: Prospective Multi-Centre Cohort Study (SCOB-II).

Source

Asare, E. V., DeBaun, M. R., Olayemi, E., Boafor, T., & Oppong, S. A. (2022). Acute pain episodes, acute chest syndrome, and pulmonary thromboembolism in pregnancy. Hematology. American Society of Hematology. Education Program, 2022(1), 388?407.https://doi.org/10.1182/hematology.2022000376

General References

Malinowski, A. K., Kuo, K. H. M., Tomlinson, G. A., Palcu, P., Ward, R., & Shehata, N. (2021). Distinct maternal and fetal pregnancy outcomes in women with sickle cell disease can be predicted using routine clinical and laboratory data. British journal of haematology, 194(6), 1063?1073. https://doi.org/10.1111/bjh.17607

Sickle Cell Disease Obstetric Multi-Disciplinary Care Programme: Prospective Multi-Centre Cohort Study (SCOB-II). Crf 19 Interim Hospitalization. Questions 5e?7.

Protocol ID

890601

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX890601_Acute_Chest_Syndrome_Pregnancy_ACS_During_Hospitalization
	PX890601070000	Acute Chest Syndrome Diagnosis: Did the more inpatient care team diagnose acute chest syndrome during hospitalization? show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS
	PX890601050000	Current Pregnancy: Acute chest syndrome	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Episode_Number
	PX890601050100	Current Pregnancy: If yes: # of distinct ACS more episodes during current study pregnancy show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Features_Chest_Pain
	PX890601050500	Current Pregnancy: Chest Pain	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Features_Chest_Radiodensity
	PX890601051100	Current Pregnancy: New radiodensity on chest more x-ray (CXR) show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Features_Fever
	PX890601050700	Current Pregnancy: Fever (Temp > 38oC)	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Features_Oxygen_Demand_Increase
	PX890601050900	Current Pregnancy: Increase in oxygen more requirement/demand show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Features_Oxygen_SpO2_Drop
	PX890601051000	Current Pregnancy: SpO2: < 94% OR drop by 3% more below baseline show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Features_PAC
	PX890601050600	Current Pregnancy: Positive Auscultatory more Chest signs show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Features_Respiratory_Distress
	PX890601050800	Current Pregnancy: Signs of respiratory more distress (RR > 20 per minute) show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_GA_First_Event
	PX890601050200	If yes: GA at 1st event Gestational age in more weeks with days as decimal point 12 1/7 = 12.1 12 2/7 = 12.3 12 3/7 = 12.4 12 4/7 = 12.6 12 5/7 = 12.7 12 6/7 = 12.9 show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_Hospitalization
	PX890601050400	Current Pregnancy: If yes: ACS during more current study pregnancy requiring hospitalization (but not ICU care) show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_ACS_ICU
	PX890601050300	Current Pregnancy: If yes: ICU admission	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_Hyperhemolysis
	PX890601030000	Current Pregnancy: Hyperhemolysis	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Current_Pregnancy_Pneumonia
	PX890601040000	Current Pregnancy: Pneumonia (choose only in more absence of ACS; if features of ACS, choose ACS ) instead show less	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Past_Medical_ACS
	PX890601010000	Past Medical History: Acute chest syndrome	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Past_Medical_ACS_Hospitalization
	PX890601010100	Past Medical History: If yes: Hospitalization	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Past_Medical_ACS_ICU
	PX890601010200	Past Medical History: If yes: ICU admission	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Previous_Pregnancy_ACS
	PX890601020000	Previous Pregnancy: ACS requiring hospitalization	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Previous_Pregnancy_ACS_Exchange_Transfusion
	PX890601020200	Previous Pregnancy: If yes: exchange transfusion	N/A
PX890601_Acute_Chest_Syndrome_Pregnancy_Previous_Pregnancy_ACS_Simple_Transfusion
	PX890601020100	Previous Pregnancy: If yes: simple transfusion	N/A

SCD Pregnancy

Measure Name

Acute Chest Syndrome - Pregnancy

Release Date

August 5, 2024

Definition

Acute chest syndrome is a heterogenous complication of sickle cell disease caused by blockage of lung blood vessels by sickled red cells and characterized by fever, hypoxia, leukocytosis, and new pulmonary infiltrates.

Purpose

Acute chest syndrome (ACS) occurs in both children and adults with sickle cell disease (SCD). ACS is a life-threatening emergency in SCD contributing to morbidity, hospitalization, and death.

Keywords

Pneumonia, respiratory complications, respiratory infection, lung congestion, sickle cell disease complications, SCD, acute chest syndrome, ACS.

Measure Protocols

Protocol ID	Protocol Name
890601	Acute Chest Syndrome - Pregnancy

Publications

There are no publications listed for this protocol.