THE FUTILITY OF THE CHEST RADIOGRAPH IN THE FEBRILE INFANT WITHOUT RESPIRATORY SYMPTOMS

Objective. Major pediatric textbooks advocate a chest radiograph as pa rt of the diagnostic evaluation for a sepsis workup for febrile infant s less than 3 months old. Very few studies have addressed the value of performing a chest radiograph in this situation. Two studies previous ly published lack the numbers to statistically justify a conclusion ab out the need to perform a chest radiograph in the febrile infant. Meth ods. Evaluated were 197 febrile infants 3 months old or less with a hi story, physical examination, chest radiograph, and other laboratory st udies 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 comb ined group resulted in 617 infants. Results. The combined group of inf ants 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 chan ce of a positive chest radiograph in a patient with no pulmonary sympt oms would occur less than 1.02% of the time. Conclusions. The generall y advocated policy of obtaining a chest radiograph as part of the seps is workup in febrile infants should be discontinued, and chest radiogr aphs should be obtained only in febrile infants who have clinical indi cations of pulmonary disease.