The futility of the chest radiograph in the febrile infant without respiratory symptoms
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 t...
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| Veröffentlicht in: | Pediatrics (Evanston) 1993-10, Vol.92 (4), p.524-526 |
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| creator | BRAMSON, R. T MEYER, T. L SILBIGER, M. L BLICKMAN, J. G HALPERN, E |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1542/peds.92.4.524 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.92.4.524</identifier><identifier>PMID: 8414821</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: American Academy of Pediatrics</publisher><subject>Bacterial infections ; Biological and medical sciences ; Chest ; Childhood fever ; Diagnosis ; Fever in children ; Fever of Unknown Origin - epidemiology ; Fever of Unknown Origin - etiology ; Humans ; Infant ; Investigative techniques, diagnostic techniques (general aspects) ; Lung - diagnostic imaging ; Medical imaging ; Medical research ; Medical sciences ; Pediatrics ; Predictive Value of Tests ; Probability ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiography ; Respiratory system ; Respiratory Tract Infections - diagnostic imaging ; Respiratory Tract Infections - epidemiology ; Thorax</subject><ispartof>Pediatrics (Evanston), 1993-10, Vol.92 (4), p.524-526</ispartof><rights>1993 INIST-CNRS</rights><rights>COPYRIGHT 1993 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Oct 1993</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-698db6fe2596b0ef3be2b657221b59da3ae3cdadedca62baeb23020d1e3f9c623</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4910122$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8414821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BRAMSON, R. T</creatorcontrib><creatorcontrib>MEYER, T. L</creatorcontrib><creatorcontrib>SILBIGER, M. L</creatorcontrib><creatorcontrib>BLICKMAN, J. G</creatorcontrib><creatorcontrib>HALPERN, E</creatorcontrib><title>The futility of the chest radiograph in the febrile infant without respiratory symptoms</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>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.
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.
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.
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.</description><subject>Bacterial infections</subject><subject>Biological and medical sciences</subject><subject>Chest</subject><subject>Childhood fever</subject><subject>Diagnosis</subject><subject>Fever in children</subject><subject>Fever of Unknown Origin - epidemiology</subject><subject>Fever of Unknown Origin - etiology</subject><subject>Humans</subject><subject>Infant</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Lung - diagnostic imaging</subject><subject>Medical imaging</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Pediatrics</subject><subject>Predictive Value of Tests</subject><subject>Probability</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiography</subject><subject>Respiratory system</subject><subject>Respiratory Tract Infections - diagnostic imaging</subject><subject>Respiratory Tract Infections - epidemiology</subject><subject>Thorax</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0Utr3DAUBWBRGtJJ2mWXBVNCVvVUL3vkZRj6gkA2KV0KPa5mFGTLlWSS-fdROkMWXYmr-yEOOgh9JHhNOk6_zmDzeqBrvu4of4NWBA-i5XTTvUUrjBlpOcbdO3SR8wPGmHcbeo7OBSdcULJCf-730Lil-ODLoYmuKXU2e8ilScr6uEtq3jd--nfvQCcfoI5OTaV59GUflwohzz6pEtOhyYdxLnHM79GZUyHDh9N5iX5__3a__dne3v34tb25bQ0TpLT9IKzuHdBu6DUGxzRQ3deMlOhusIopYMYqC9aonmoFmjJMsSXA3GB6yi7R9fHdOcW_S40tR58NhKAmiEuWm77-QU9IhZ__gw9xSVPNJikVbIMFwRV9OaKdCiD9ZOJU4KmYGALsQNbk2zt5QzgXHWOi8vbITYo5J3ByTn5U6SAJli_lyJdy5EAll7Wc6j-dMix6BPuqT23U_dVpr7JRwSU1GZ9fGR8IJpSyZ4E_mB0</recordid><startdate>19931001</startdate><enddate>19931001</enddate><creator>BRAMSON, R. 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G ; HALPERN, E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-698db6fe2596b0ef3be2b657221b59da3ae3cdadedca62baeb23020d1e3f9c623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Bacterial infections</topic><topic>Biological and medical sciences</topic><topic>Chest</topic><topic>Childhood fever</topic><topic>Diagnosis</topic><topic>Fever in children</topic><topic>Fever of Unknown Origin - epidemiology</topic><topic>Fever of Unknown Origin - etiology</topic><topic>Humans</topic><topic>Infant</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Lung - diagnostic imaging</topic><topic>Medical imaging</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Pediatrics</topic><topic>Predictive Value of Tests</topic><topic>Probability</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Radiography</topic><topic>Respiratory system</topic><topic>Respiratory Tract Infections - diagnostic imaging</topic><topic>Respiratory Tract Infections - epidemiology</topic><topic>Thorax</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BRAMSON, R. T</creatorcontrib><creatorcontrib>MEYER, T. L</creatorcontrib><creatorcontrib>SILBIGER, M. L</creatorcontrib><creatorcontrib>BLICKMAN, J. 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G</au><au>HALPERN, E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The futility of the chest radiograph in the febrile infant without respiratory symptoms</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>1993-10-01</date><risdate>1993</risdate><volume>92</volume><issue>4</issue><spage>524</spage><epage>526</epage><pages>524-526</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>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.
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.
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.
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.</abstract><cop>Elk Grove Village, IL</cop><pub>American Academy of Pediatrics</pub><pmid>8414821</pmid><doi>10.1542/peds.92.4.524</doi><tpages>3</tpages></addata></record> |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals |
| subjects | Bacterial infections Biological and medical sciences Chest Childhood fever Diagnosis Fever in children Fever of Unknown Origin - epidemiology Fever of Unknown Origin - etiology Humans Infant Investigative techniques, diagnostic techniques (general aspects) Lung - diagnostic imaging Medical imaging Medical research Medical sciences Pediatrics Predictive Value of Tests Probability Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiography Respiratory system Respiratory Tract Infections - diagnostic imaging Respiratory Tract Infections - epidemiology Thorax |
| title | The futility of the chest radiograph in the febrile infant without respiratory symptoms |
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