Limited Diagnostic and Therapeutic Value of Chest X-Rays in Hematological Patients With Febrile Neutropenia

In hematological patients with febrile neutropenia, chest X-rays are frequently performed to exclude possible pulmonary infections. However, the diagnostic and therapeutic value of this imaging remains unclear. We conducted a retrospective observational cohort study over a 2-year period, examining episodes of febrile neutropenia in adult patients treated with myelosuppressive chemotherapy. Febrile episodes were categorized based on the presence (group A) or absence (group B) of respiratory symptoms. We assessed the frequency of abnormal chest X-rays and chest computed tomography (CT) scans and their impact on antimicrobial treatment decisions. Of the 412 febrile episodes in 259 patients, 41.4% in group A and 16.1% in group B had an abnormal chest X-ray (P < .001). X-rays showing infiltrates were followed by chest CT in 51.5%. Antimicrobial treatment decisions were rarely based on results of X-rays: 6.9% (95% confidence interval [CI], 2.4%-15.6%) in group A and 3.4% (95% CI, 1.9%-5.7%) in group B (P = .200). In group A, however, antimicrobial treatment was more often adjusted based on an ensuing abnormal CT: 17.2% (95% CI, 9.2%-28.4%) versus 6.2% (95% CI, 4.0%-9.1%) (P = .004). Chest X-rays rarely influence antibiotic treatment decisions in febrile neutropenia and can probably be safely omitted, especially in patients without respiratory symptoms.