Journal of Clinical Oncology, Vol 6, 1699-1702, Copyright © 1988 by American Society of Clinical Oncology
Use of routine chest radiography in the evaluation of fever in neutropenic pediatric oncology patients
J Feusner, R Cohen, M O'Leary and B Beach
Department of Hematology/Oncology, Children's Hospital Oakland, CA 94609.
Evaluation of febrile episodes in children who have become neutropenic
during treatment for malignant disease has traditionally included
radiography of the chest. It has been our impression that the yield of such
examination is low. To test this hypothesis we reviewed all chest
radiographs (CXRs) obtained in the above setting in our institution over
the last 3 years. These radiographs were independently reviewed by two of
us (R.C., J.F.). Sixty-one patients experienced 134 febrile neutropenic
episodes for which a CXR was obtained. Only eight (6%) of these films
revealed any abnormality. After careful review it was apparent that four of
these radiographs did not represent a infectious process. Thus only four of
134 films (2.9%) indicated pulmonary infection as the probable cause of
fever in the patient. All four of these patients had prominent respiratory
signs or symptoms. Of patients who were febrile but without pulmonary
signs/symptoms, only one of 49 had an abnormal radiograph. We feel that
such a low yield (at most 2%) calls into question the routine practice of
obtaining a CXR in the febrile neutropenic child who is otherwise
asymptomatic.
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