Predictors of Critical Care Interventions and Length of Stay in Pediatric Sickle Cell Acute Chest Syndrome: A Five-Year Pediatric Intensive Care Unit (PICU) Cohort Study.

Introduction Acute chest syndrome (ACS) remains one of the most severe complications of pediatric sickle cell anemia (SCA) and a leading cause of Pediatric Intensive Care Unit (PICU) admission. Despite its clinical significance, regional data describing PICU-level characteristics, interventions, and outcomes in children with SCA are limited. This study aimed to evaluate the clinical profile, management strategies, and outcomes of pediatric SCA patients admitted to the PICU at a tertiary care center in Tabuk, Saudi Arabia. Methods We conducted a retrospective cohort study of pediatric patients aged one to 14 years with confirmed SCA admitted to the PICU for ACS between January 2020 and January 2025 (five-year period) at King Salman Armed Forces Hospital, Tabuk. Demographic data, laboratory parameters, prior disease history, PICU interventions, and clinical outcomes were extracted from medical records. Associations between clinical predictors and major interventions were evaluated using chi-square/Fisher's exact testing. Predictors of PICU length of stay were analyzed using comparative statistical methods. Results Forty-one patients were included (mean age 8.71 ± 3.54 years); 25 (61.0%) were male. Most patients had the homozygous sickle cell disease (HbSS) genotype (36 (87.8%)), and 30 (73.2%) were receiving hydroxyurea. Exchange transfusion was performed in 29 (70.7%) admissions, while mechanical ventilation was required in two (4.9%). Exchange transfusion was not significantly associated with demographic or baseline clinical variables. Although Fisher's exact testing demonstrated statistical significance for prior ICU admission (p = 0.034) and prior stroke (p = 0.007), the very small number of ventilation events (n = 2) limits the robustness of these associations. These findings should therefore be interpreted with caution. Mean PICU length of stay was 3.24 ± 2.80 days and was significantly longer among patients with a history of stroke (p = 0.003). In-PICU complications were uncommon. Conclusion In this five-year single-center retrospective cohort of pediatric patients with SCA admitted to the PICU for ACS, exchange transfusion was frequently utilized, whereas invasive mechanical ventilation was uncommon. A signal toward greater PICU severity was observed among patients with prior neurologic events or prior ICU exposure; however, given the small sample size and limited number of ventilation events, these observations should be interpreted with caution. Larger, multicenter prospective studies are needed to further clarify risk stratification and inform evidence-based critical care planning in this population.