PEDIATRICS Vol. 92 No. 4 October 1993, pp. 524-526
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The Futility of the Chest Radiograph in the Febrile Infant Without Respiratory Symptoms

Robert T. Bramson MD1, Theo L. Meyer MD2, Martin L. Silbiger MD3, Johan G. Blickman MD4, and Elkan Halpern PhD5

1 The Department of Radiology, University of South Florida College of Medicine, Tampa General Hospital, Tampa, FL; the Division of Pediatric Imaging, Massachusetts General Hospital, Boston, MA
2 The Department of Pediatrics, University of South Florida College of Medicine, Tampa General Hospital. Tampa, FL
3 The Department of Radiology, University of South Florida College of Medicine, Tampa General Hospital, Tampa, FL
4 The Division of Pediatric Imaging, Massachusetts General Hospital, Boston, MA
5 The Center for Imaging and Pharmaceutical Research, Massachusetts General Hospital, Boston MA.

Objective. Major pediatric textbooks advocate a chest radiograph as part of the diagnostic evaluation for a sepsis workup for febrile infants less than 3 months old. Very few studies have addressed the value of performing a chest radiograph in this situation. Two studies previously published lack the numbers to statistically justify a conclusion about the need to perform a chest radiograph in the febrile infant.

Methods. Evaluated were 197 febrile infants 3 months old or less with a history, physical examination, chest radiograph, and other laboratory studies to determine the cause of their fever. This group of infants was combined with the group of infants from two similar studies published previously in the literature using cumulative meta-analysis. The combined group resulted in 617 infants.

Results. The combined group of infants had 361 infants who had no clinical evidence of pulmonary disease on history or physical examination. All 361 infants had normal chest radiograph. These results gave a 95% confidence interval that the chance of a positive chest radiograph in a patient with no pulmonary symptoms would occur less than 1.02% of the time.

Conclusions. The generally advocated policy of obtaining a chest radiograph as part of the sepsis workup in febrile infants should be discontinued, and chest radiographs should be obtained only in febrile infants who have clinical indications of pulmonary disease.

Key Words: chest radiographs • sepsis workup • infants • fever

Submitted on March 8, 1993
Accepted on April 15, 1993




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