Likelihood of Occult Pneumonia in Febrile Children
Emily M. Herzberg
Lauren Allister
Occult Pneumonias: Empiric Chest Radiographs in Febrile Children With Leukocytosis
Bachur R, Perry H, Harper MB. Ann Emerg Med. 1999;33(2):166–173
Background
The evaluation of febrile children is diagnostically challenging. In febrile children with leukocytosis and respiratory symptoms, chest radiographs (CXRs) are often performed to evaluate for underlying pneumonia. However, performance of CXR in febrile children without respiratory symptoms was not standard practice. This study was the first to examine the utility of CXR in febrile children with no clinically identifiable source.
Objectives
To evaluate the incidence of radiographic pneumonia in children with fever and leukocytosis without a source of infection on examination.
Methods
Prospective cohort study at a single US center from 1994 to 1995.
Patients
278 patients ages <5 years with leukocytosis (white blood cell [WBC] count >20,000/mm3) and temperature >39.0°C. Select exclusion criteria: immunodeficiency, chronic lung disease, identified source of major bacterial infection (otitis media not included).
Intervention
Pneumonia diagnosed by CXR in children without respiratory signs (tachypnea, increased work of breathing, oxygen desaturation) in comparison to children who underwent CXR due to clinical concern for pneumonia.
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