The utility of computed tomography in the management of fever and neutropenia in pediatric oncology

Rao et al, 2015 Pediatric Blood and Cancer                                                         

Link to abstract: http://onlinelibrary.wiley.com/doi/10.1002/pbc.25561/abstract

Retrospective cohort study including oncology patients admitted with F&N from 2003-2009, ≤21 years. Median duration of admission was 5 days (range 0-79), 22% of patients had a CT scan (139 scans in 93 individuals).  21% of those who had a scan had multiple scans during the admission.  68% of scans included chest, 69% included abdomen, 41% included head, & 55% pan-scans (>1 body part).

Risk factors for having a scan: older age (≥7 years), longer admission (≥7 days), positive culture from non-blood source, findings on CXR, additional disease burden (“sicker” patients, not well defined) or symptoms in addition to F&N at presentation. 

Pan-scans more likely in younger patients (<7 years), pts with hematologic malignancy, history of fungal infection, +ve blood cultures or +ve viral PCR, pts without additional symptoms beyond F&N. 

66% of scans identified possible source of infection – sinusitis (27%), pulmonary infiltrate (27%), possible fungal lesions (17%).  Factors associated with finding infection: African American  race, hypotension, chest CT alone, head CT alone or included in pan-scan, scan done ≥7 days after admission. 

*In 41%, CT led to a change in management, most often change in antibiotic (53%) or antiviral/antifungal (42%).  Pan-scans seemed not more effective, abdominal scan were good at ruling out infection but not good to identify infection (i.e. usually not helpful).