The utility of computed tomography in the management of fever and neutropenia in pediatric oncology.
Despite the frequent use and radiation exposure of computed tomography (CT) scans, there is little information on patterns of CT use and their utility in the management of pediatric patients with fever and neutropenia (FN). We examined the contribution of either the commonly employed pan-CT (multiple anatomical locations) or targeted CT (single location) scanning to identify possible infectious etiologies in this challenging clinical scenario. Procedure Pediatric patients with an underlying malignancy admitted for fever (temperature ≥ 38.3 °C) and an absolute neutrophil count <500 cells/μL from 2003-2009 were included. Risk factors associated with utilization, results, and effects on clinical management of CT scans were identified. Results Charts for 635 admissions for FN from 263 patients were reviewed. Overall, 139 (22%) admissions (93 individuals) had at least one scan. Of 188 scans, 103 (55%) were pan-scans. Changes in management were most strongly associated with the identification of evidence consistent with infection (OR = 12.64, 95% CI: 5.05-31.60, P < 0.001). Seventy-eight (41%) of all CT scans led to a change in clinical management, most commonly relating to use of antibiotic (N = 41, 53%) or antifungal/antiviral medications (N = 33, 42%). The odds of a change in clinical management did not differ for those receiving a pan-scan compared to those receiving a targeted scan (OR = 1.23; 95% CI, 0.61-2.46; P = 0.57). Conclusions When CT is clinically indicated, it is important for clinicians to strongly consider utilizing a targeted scan to reduce radiation exposure to patients as well as to decrease costs without compromising care.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Avani D
AD
Rao
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.|Departments of Biostatistics and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Elizabeth A
EA
Sugar
Department of Hematology, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK.
Neil
N
Barrett
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Mahadevappa
M
Mahesh
Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona.
Robert J
RJ
Arceci
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000000981:diagnostic imaging* / Q000209:etiology; D010372:Pediatrics; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D055815:Young Adult
computed tomography; fever and neutropenia; pediatric oncology