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Vaso‐occlusive crisis as a predictor of symptomatic avascular necrosis in children with sickle cell disease

Avascular necrosis (AVN) is a chronic bone complication of sickle cell disease (SCD) resulting in significant morbidity. Understanding associated risk factors can facilitate risk‐based screening, earlier identification, and prompt intervention. Between 1998 and 2014, 26 symptomatic cases with imaging evidence of AVN were compared 1:5 with age‐ and SCD genotype‐matched controls (n = 128). Patients with 1–5 vaso‐occlusive crisis (VOC) (OR 11.9, 95% CI, 1.4–99.9; P = 0.02) and more than 5 VOC (OR 53.6, 95% CI, 5.5–520.2; P = 0.0006) in a 5‐year period were more likely to have AVN. Symptomatic patients with more than five VOC in 5 years may benefit from radiologic screening for AVN.