Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/18177
Title: Limited utility of routine chest X-ray in initial evaluation of neutropenic fever in patients with haematological diseases undergoing chemotherapy.
Authors: Estacio, Ortis;Loh, Zoe;Baker, Amy;Chong, Geoffrey;Grigg, Andrew P;Churilov, Leonid;Hawkes, Eliza A
Affiliation: Department of Medicine, Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
Department of Clinical Haematology, Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
Statistics and Decision Analysis Academic Platform, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
Eastern Clinical Research Unit, Eastern Health Monash University Clinical School, Melbourne, Victoria, Australia
Department of Medical Oncology, Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
Issue Date: May-2018
Citation: Internal Medicine Journal 2018; 48(5): 556-560
Abstract: Routine chest X-ray (CXR) is recommended for neutropenic fever (NF) management however its role is relatively understudied in haematology patients. To investigate the utility of CXR in the diagnosis and management of patients with haematological conditions complicated by NF. Retrospective, single-centre analysis of haematology patients admitted with NF between January 2011 and December 2015. Baseline demographics, treatment details and outcomes were collected from electronic patient records. CXR underwent independent radiology review. Primary endpoints were a proportion of NF episodes in which CXR detected a probable chest infection in the absence of respiratory symptoms/signs and/or resulted in a change in antibiotic management. Four hundred and thirty-five episodes were identified; CXR was performed in 75% of patients (65% within 2 days of NF). In 4 of 164 (2.4%) asymptomatic patients, CXR was consistent with infection, in contrast to 19 of 119 (16%) patients with clinical signs of respiratory infection. Only 3 of 283 (1.1%) CXR resulted in a change to antibiotics. CXR consistent with infection was not associated with increased mortality or increased admission length, although there was an association with intensive care unit admission (odds ratios: 7.61, 95% confidence interval: 2.04-28.31). In haematology patients with NF, CXR rarely detected chest infection or changed management in patients with no respiratory symptoms or signs. CXR in our institution is no longer part of routine assessment of NF in the absence of these features.
URI: http://ahro.austin.org.au/austinjspui/handle/1/18177
DOI: 10.1111/imj.13712
ORCID: 0000-0002-0376-2559
0000-0002-9807-6606
PubMed URL: 29227565
Type: Journal Article
Subjects: chest X-ray
choosing wisely
haematological malignancy
neutropenic fever
Appears in Collections:Journal articles

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