title: Systematic review and meta-analysis of the value of clinical features to exclude radiographic pneumonia in febrile neutropenic episodes in children and young people.
abstract: BACKGROUND
  Children and young people who present with febrile neutropenia (FNP) secondary to malignancies or their treatment frequently do not undergo routine chest radiography. With shorter courses of antibiotic therapy, failure to recognise pneumonia and consequent under-treatment could produce significant problems.
  
  
  METHODS
  The review was conducted determine the value of the absence of clinical features of lower respiratory tract infection in excluding radiographic pneumonia at presentation of FNP using Centre for Reviews and Dissemination methods. It was registered with the HTA Registry of systematic reviews, CRD32009100453. Ten bibliographic databases, conference proceedings, reference lists and citations were searched. Cohort studies which compared clinical examination to radiographic findings were included. Results were summarised by random-effects meta-analysis.
  
  
  RESULTS
  Four studies were included. Synthesis of the three higher-quality studies gave imprecise estimates of the average sensitivity (75%; 95% CI 52% to 89%) and average specificity (69%; 95% CI 57% to 78%) for clinical examination in the detection of radiographic pneumonia. If the prevalence of pneumonia is 5%, these estimates produce a negative predictive value of 98% (95% CI 96% to 99%). Alternatively, there remains a 1.9% probability of pneumonia (95% CI 0.7% to 4.2%).
  
  
  CONCLUSIONS
  Signs and symptoms of lower respiratory infection have only moderate sensitivity and specificity for pneumonia; the low prevalence of the condition justifies the routine withholding of chest radiographs. However, for those with a predisposition to pneumonia, or re-presenting after a short course of antibiotic therapy, a chest X-ray should be performed despite an absence of signs.
authors: Centre for Reviews and Dissemination, University of York, York, UK. rp532@york.ac.uk
authors: Bob
authors: B
authors: Phillips
authors: Ros
authors: R
authors: Wade
authors: Marie
authors: M
authors: Westwood
authors: Richard
authors: R
authors: Riley
authors: Alex J
authors: AJ
authors: Sutton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000209:etiology*; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015995:Prevalence; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity