title: Diagnostic value of routine chest radiography in febrile, neutropenic children for early detection of pneumonia and mould infections.
abstract: BACKGROUND
  Despite recent studies failing to demonstrate the value of routine chest radiography (CXR) in the initial evaluation of the febrile neutropenic patient with cancer, this screening test is advocated by some experts. We evaluated the benefits of CXR for early diagnosis of pulmonary infection at St. Jude Children's Research Hospital (SJCRH) with emphasis on early recognition of mould infections.
  
  
  METHODS
  We reviewed the courses of 200 consecutive febrile neutropenic pediatric patients to determine if routine CXR at initial evaluation was useful in the identification of clinically occult pneumonia. We also reviewed all cases of proven or probable mould infections from the opening of SJCRH in 1962 until 1998 when routine CXR was no longer practiced in our institution to identify cases that were first recognized by routine CXR.
  
  
  RESULTS
  Of 200 febrile neutropenic patients, pulmonary abnormalities consistent with pneumonia were detected by routine CXR in only five patients without pulmonary signs or symptoms. In only one case was a change in management considered. Of the 70 patients with pulmonary mould infection identified from 1962 to 1998, routine CXR was performed in 45 patients at the onset of a febrile, neutropenic episode in which a mould infection was diagnosed. Routine CXR was pivotal in the recognition of the mould infection in only two cases over this 36-year period.
  
  
  CONCLUSIONS
  CXR is warranted in the evaluation of the newly febrile neutropenic pediatric oncology patient only when respiratory signs or symptoms are present.
authors.affiliation: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Roberts
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Wells
authors.forename: Nilay M
authors.initials: NM
authors.lastname: Gandhi
authors.forename: Nowell R
authors.initials: NR
authors.lastname: York
authors.forename: Gabriela
authors.initials: G
authors.lastname: Maron
authors.forename: Bassem
authors.initials: B
authors.lastname: Razzouk
authors.forename: Randall T
authors.initials: RT
authors.lastname: Hayden
authors.forename: Sue C
authors.initials: SC
authors.lastname: Kaste
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Shenep
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D005334:Fever; D005658:Fungi; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008485:Medical Audit; D009181:Mycoses / Q000000981:diagnostic imaging*; D009503:Neutropenia; D011014:Pneumonia / Q000000981:diagnostic imaging*; D011859:Radiography; D055815:Young Adult