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Chest radiographs in the evaluation of the febrile infant
R J Patterson1, G S Bisset, D R Kirks
1Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH.
Insights
Chest radiographs are essential for febrile infants only when they show clinical signs of lower respiratory tract illness. This targeted approach avoids unnecessary imaging for infants without symptoms, improving diagnostic efficiency.
Area of Science:
- Pediatric Medicine
- Radiology
- Infectious Disease
Background:
- Chest radiographs are routinely used in evaluating febrile infants, often regardless of respiratory symptoms.
- The diagnostic yield of these radiographs in young children is debated.
Purpose of the Study:
- To assess the diagnostic yield of chest radiographs in infants under 2 years old.
- To determine the necessity of chest radiography based on clinical presentation.
Main Methods:
- A retrospective study of 105 infants and a prospective study of 121 infants were conducted.
- Radiographs were considered positive only for focal parenchymal infiltrates; hyperinflation/bronchial thickening were excluded.
Main Results:
- In infants with lower respiratory tract infection symptoms, positive radiograph yield was 12-32%.
- In infants without symptoms, positive yield was 0-14% (retrospective) and 0-3% (prospective).
Conclusions:
- Chest radiography for antibiotic-treatable infiltrates in infants under 2 years old is indicated only when clinical evidence of lower respiratory tract illness is present.
- Routine chest X-rays for febrile infants without lower respiratory symptoms have a low diagnostic yield.
Abstract:
Chest radiographs are often considered an essential part of the workup of the febrile infant. Anteroposterior and lateral radiographs of the chest are frequently obtained in this group of patients, irrespective of respiratory tract symptoms and/or signs. A total of 226 children (less than or equal to 2 years old) with and without signs and symptoms of lower respiratory tract infections were examined to assess the yield of chest radiographs. The radiograph was considered positive only if a focal parenchymal infiltrate was present. Hyperinflation or bronchial thickening was not included as a positive finding because these children usually do not receive antibiotics despite the fact that viral illness or reactive airway disease may be present. In a retrospective study of 105 infants, confidence intervals for yield were established for children with (95% Cl = 12%, 32%) and without (95% Cl = 0%, 14%) symptoms or signs of lower respiratory tract infection. In a prospective study of 121 infants without chest symptoms or signs, confidence levels for positive yield were better defined (95% Cl = 0%, 3%). The data suggest that obtaining chest radiographs to look for parenchymal infiltrates treatable with antibiotics in infants less than 2 years old is necessary only in those infants who have clinical evidence of lower respiratory tract illness.