CHEST RADIOGRAPHS IN THE EVALUATION OF THE FEBRILE INFANT

Chest radiographs are often considered an essential part of the workup of the febrile infant. Anteroposterior and lateral radiographs of the chest are frequently obtained in this group of patients, irrespective of respiratory tract symptoms and/or signs. A total of 226 children (≤ 2 years old) with and without signs and symptoms of lower respiratory tract infections were examined to assess the yield of chest radiographs. The radiograph was considered positive only if a focal parenchymal infiltrate was present. Hyperinflation or bronchial thickening was not included as a positive finding because these children usually do not receive antibiotics despite the fact that viral illness or reactive airway disease may be present. In a retrospective study of 105 infants, confidence intervals for yield were established for children with (95% CI = 12%, 32%) and without (95% CI = 0%, 14%) symptoms or signs of lower respiratory tract infection. In a prospective study of 121 infants without chest symptoms or signs, confidence levels for positive yield were better defined (95% CI = 0%, 3%). The data suggest that obtaining chest radiographs to look for parenchymal infiltrates treatable with antibiotics in infants less than 2 years old is necessary only in those infants who have clinical evidence of lower respiratory tract illness.