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Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer?
Author(s) -
Renoult Edith,
Buteau Chantal,
Turgeon Nathalie,
Moghrabi Albert,
Duval Michel,
Tapiero Bruce
Publication year - 2004
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20127
Subject(s) - medicine , blood cancer , radiography , pediatric cancer , radiology , fever of unknown origin , cancer , intensive care medicine , pediatrics
Abstract Background The yield of routine chest radiography (CXR) as part of the initial management of febrile neutropenic pediatric oncology patients is questionable. Procedure We retrospectively analyzed the clinical records of neutropenic (absolute neutrophil count ≤0.5 × 10 9 /L) children with cancer, admitted with oral temperature ≥38°C to our institution, between January 2001 and October 2002. Following admission, patients received tobramycin plus (piperacillin or ticarcillin–clavulanic acid). Admission routine CXRs were reviewed. Clinical and radiological features were compared with the discharge diagnosis. Age, underlying disease, and the presence of pulmonary symptoms or signs were studied as possible predictors of CXR findings related to pneumonia. Results In total, 88 patients experienced 170 episodes of fever. A routine admission CXR was obtained for 157 of the episodes. Radiologists found 20 (12.7%) abnormal CXR (6 with a segmental or lobar consolidation considered as a pneumonia). In addition, two patients with abnormal admission CXR developed lobar consolidation on a repeat film, later in their hospital course. There were no differences in age and type of underlying disease between children with or without pneumonia. Respiratory symptoms were initially present in 58 cases. Seven (12%) had pneumonia. Among the 99 asymptomatic cases only one (1%) patient had a pneumonia ( P = 0.0041). This child had a positive blood culture for P. aeruginosa at the time of admission. None of the children had initial therapy modified on the basis of radiologic findings. Conclusion In this study, pneumonia is an unusual cause of fever (5%), especially in the absence of respiratory signs or symptoms (1%). Admission CXR should be reserved for the neutropenic pediatric oncology patient presenting with fever and abnormal respiratory findings. © 2004 Wiley‐Liss, Inc.