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

Abstract Background 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. Methods 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. Results 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). Conclusions Chest X-rays rarely influence antibiotic treatment decisions in febrile neutropenia and can probably be safely omitted, especially in patients without respiratory symptoms.

• Publication year

  2025

• Venue

  Open Forum Infectious Diseases

• Publication date

  2025-07-18

• Fields of study

  Medicine

• Identifiers
  DOI 10.1093/ofid/ofaf419PMID 40756648PMCID 12310566
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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