Abstract
Pulmonary infections are not uncommon in patients with febrile neutropenia. Physicians have agreed to perform a chest X-ray (CXR) for all febrile neutropenic patients presenting with respiratory signs/symptoms. Nevertheless, they were divided into two groups when it came to asymptomatic febrile neutropenic patients (i.e. without respiratory signs/symptoms). A superior alternative to CXR is Computed Tomography (CT). CT, in comparison to CXR, was shown to have better sensitivity in detecting pulmonary foci. The aim of our study is to compare the diagnostic performance of CT and CXR in febrile neutropenic patients presenting to the emergency department, regardless of their clinical presentation. We are also interested in the predictors of pneumonia on chest imaging. This is a retrospective cohort study conducted on febrile neutropenic adult cancer patients presenting to the emergency department of the American University of Beirut Medical Center. 11.4% of 263 patients had pneumonia although 27.7% had respiratory signs/symptoms. 17.1% of those who were symptomatic and did a CXR were found to have pneumonia. 41.7% of those who were symptomatic and did a CT were found to have pneumonia. 30% had negative findings on CXR but pneumonia on CT. Patients with positive findings of pneumonia on chest imaging mainly had solid tumors, profound neutropenia, a higher CCI and a longer LOS. The presence of respiratory signs is the main predictor of positive pneumonia on chest imaging. CT is superior to CXR in detecting pulmonary foci in the population studied.
Highlights
Pulmonary infections are not uncommon in patients with febrile neutropenia
The primary aim of our study is to compare the diagnostic performance of Low Dose- CT (LDCT) and chest X-ray (CXR) in febrile neutropenic patients presenting to the Emergency Department (ED), irrespective of their clinical presentation
As well, aim to assess the value of Computed Tomography (CT) in comparison to CXR as means to make fast but accurate diagnoses in such a vulnerable population. Those who were positive for pneumonia mainly had solid tumors (51.7%) and more than three-quarters (76.7%) had profound neutropenia
Summary
Physicians have agreed to perform a chest X-ray (CXR) for all febrile neutropenic patients presenting with respiratory signs/symptoms. The aim of our study is to compare the diagnostic performance of CT and CXR in febrile neutropenic patients presenting to the emergency department, regardless of their clinical presentation. Conclusion: Patients with positive findings of pneumonia on chest imaging mainly had solid tumors, profound neutropenia, a higher CCI and a longer LOS. Despite being comprehensively worked up, 44% of these patients do not have a focus of infection identified [7] This could either be due to the use of prophylactic antimicrobial therapy in the population under study [8,9,10] or due to the low sensitivity of plain chest radiographs that are commonly performed in the ED [11]. No matter what the cause of inability or delay to detect the focus of infection is, it puts patients from a vulnerable population into further risks and complications [12]
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