The utility of chest X-ray vs. computed tomography in febrile neutropenia patients presenting to the emergency department

  • Imad El Majzoub Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  • Aline El Zakhem Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  • Rola Cheaito Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  • Mohamad Ali Cheaito Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  • Rima Kaddoura Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  • Maria Alkozah Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  • Hady Zgheib Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Keywords: Chest X-ray, Computed Tomography, Emergency Department, Febrile Neutropenia, Respiratory Signs and Symptoms

Abstract

Introduction: 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.

Methodology: 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.

Results: 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.

Conclusion: 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.

Published
2020-10-31
How to Cite
1.
El Majzoub I, El Zakhem A, Cheaito R, Cheaito MA, Kaddoura R, Alkozah M, Zgheib H (2020) The utility of chest X-ray vs. computed tomography in febrile neutropenia patients presenting to the emergency department. J Infect Dev Ctries 14:1178-1184. doi: 10.3855/jidc.12577
Section
Original Articles