A Short Course of Prednisone in the Management of Acute Chest Syndrome of Sickle Cell Disease

Background: A short course of dexamethasone therapy may attenuate the course of acute chest syndrome (ACS) of sickle cell disease, but it also increases the risk of early readmission after discharge. Over several years at our institution, an "asthma regimen" of prednisone [2 mg/kg/d (max 80 mg) in 2 divided doses for 5 days] has increasingly been used to treat moderate-to-severe ACS. Methods: Review of medical records identified 63 patients hospitalized 78 times with ACS over a 2-year period. The clinical course of patients who received prednisone was compared with that of those who did not, particularly to assess the frequency of early (within 2 weeks) readmission after discharge. Results: Eight (15.1%) of the 53 children receiving prednisone and 2 (8%) of the 25 who did not were readmitted within 2 weeks (P = 0.33), usually for treatment of pain. Patients with moderate-to-severe ACS were more likely to receive prednisone. There was no difference in the duration of stay or the need for blood transfusion between the 2 groups; 21.8% of all the patients received blood. Conclusion: A short course of prednisone did not significantly increase readmission rate after discharge. Larger prospective studies are needed to confirm safety and to establish efficacy.