title: The utility of routine chest radiography in the initial evaluation of adult patients with febrile neutropenia patients undergoing HSCT.
abstract: BACKGROUND
  The routine use of chest radiographs (CXRs) in the initial evaluation of asymptomatic patients with febrile neutropenia undergoing hematopoietic stem cell transplant (HSCT) is controversial.
  
  
  OBJECTIVE
  The goal of this study was to document the incidence of pneumonia demonstrated on CXR during an initial febrile neutropenic episode in adult patients undergoing HSCT.
  
  
  METHODS
  Clinical records of 1083 adult patients undergoing autologous (n=766), allogeneic (n=269), or umbilical cord blood HSCT (n=48) between October 1, 2009, and December 31, 2012, were retrospectively reviewed. CXRs obtained at the initial febrile neutropenic episode were evaluated for radiologic features of pneumonia. The presence of clinical symptoms, length of stay (LOS), and readmission rates were assessed.
  
  
  RESULTS
  A total of 817 (75%) febrile neutropenic episodes were noted. Of the patients with neutropenic fevers, 455 (55%) had CXRs. Of the 76 patients with respiratory symptoms at the time of CXR, 24 (31.6%) had findings suggestive of pneumonia. None of the 379 CXRs performed in the absence of symptoms revealed an infectious process (P=.0001). Moreover, the mean LOS was 23.8 days for patients receiving a CXR compared with 22.2 days (P=.04) in patients without a CXR. Additionally, in patients who had CXRs, 15.7% were readmitted within 30 days compared with 7.4% in those without CXRs (P=.0004).
  
  
  CONCLUSIONS
  Indiscriminate routine CXR at the time of first neutropenic fever in asymptomatic adults undergoing HSCT is unlikely to reveal an infectious process or change clinical practice, and may be associated with increased LOS and readmission rates.
authors.affiliation: From the Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Yolin-Raley
authors.affiliation: From the Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ibiayi
authors.initials: I
authors.lastname: Dagogo-Jack
authors.affiliation: From the Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Niell
authors.affiliation: From the Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.affiliation: From the Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: From the Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.affiliation: From the Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Brett E
authors.initials: BE
authors.lastname: Glotzbecker
mesh_terms: D000328:Adult; D000368:Aged; D064147:Febrile Neutropenia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D063868:Patient Outcome Assessment; D013902:Radiography, Thoracic; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D055815:Young Adult