Korones D N, Hussong M R, Gullace M A
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York 14642, USA.
Cancer. 1997 Sep 15;80(6):1160-4.
Although there have been two reports suggesting that it is not necessary to obtain chest radiographs of all children with cancer who are hospitalized for fever and neutropenia, this practice continues.
Fifty-four children with cancer who were hospitalized for 108 episodes of fever and neutropenia were followed prospectively. Data on their respiratory signs and symptoms were collected on admission and throughout their hospital course. Chest radiographs were obtained at the discretion of the pediatric oncology attending physician and were interpreted by a pediatric radiologist.
Pneumonia was documented by chest radiograph in 4 of the 108 episodes (3.7%) of fever and neutropenia. In 10 of the 108 episodes, the children had abnormal respiratory findings; this group included the 4 children with pneumonia documented by chest X-ray examination. None of the children with normal respiratory findings hospitalized for the remaining 98 episodes had pneumonia. Chest radiographs were not obtained for 40 of the 108 episodes of fever and neutropenia. None of the children with these 40 episodes had respiratory abnormalities and all recovered without a problem. Chest radiographs were obtained for the remaining 68 episodes of fever and neutropenia. Of the four children in this group with pneumonia documented by chest X-ray, two were diagnosed on admission, and another two whose initial radiographs were normal developed pneumonia later in their hospital course. There were no differences in age, absolute neutrophil count, temperature at presentation, or type of malignancy between the children who had chest radiographs and the children who did not.
Pneumonia is an uncommon cause of infection in children with cancer hospitalized for fever and neutropenia. Therefore, the authors believe it is not necessary to obtain a chest radiograph in children with no respiratory abnormalities who are hospitalized for fever and neutropenia. [See editorial on pages 1009-10, this issue.]
尽管已有两份报告表明，对于所有因发热和中性粒细胞减少而住院的癌症患儿，无需进行胸部X光检查，但这种做法仍在继续。
对54名因发热和中性粒细胞减少而住院108次的癌症患儿进行前瞻性随访。在入院时及整个住院期间收集他们的呼吸道症状和体征数据。胸部X光片由儿科肿瘤主治医生酌情获取，并由儿科放射科医生解读。
在108次发热和中性粒细胞减少发作中，有4次（3.7%）经胸部X光片证实患有肺炎。在108次发作中有10次，患儿有异常呼吸道表现；该组包括4名经胸部X光检查证实患有肺炎的患儿。其余98次发作且呼吸道检查结果正常而住院的患儿均未患肺炎。在108次发热和中性粒细胞减少发作中，有40次未进行胸部X光检查。这40次发作的患儿均无呼吸道异常，且全部顺利康复。其余68次发热和中性粒细胞减少发作均进行了胸部X光检查。在该组经胸部X光证实患有肺炎的4名患儿中，2名在入院时被诊断出，另外2名最初X光片正常的患儿在住院后期患上了肺炎。进行胸部X光检查的患儿与未进行检查的患儿在年龄、绝对中性粒细胞计数、就诊时体温或恶性肿瘤类型方面均无差异。
肺炎是因发热和中性粒细胞减少而住院的癌症患儿感染的罕见原因。因此，作者认为，对于因发热和中性粒细胞减少而住院且无呼吸道异常的患儿，无需进行胸部X光检查。[见本期第1009 - 10页的社论。]
