Chest X-Ray Does Not Have Diagnostic Value in Patients With Fever, No Respiratory Signs or Symptoms

April 17, 2019

By Shazia Qureshi

AMSTERDAM, the Netherlands -- April 16, 2019 -- A study assessing emergency department patients presenting with fever or elevated C-reactive protein (CRP) suggests that chest x-ray might not be a useful diagnostic if no other signs or symptoms of pneumonia are present.

However, if taking the patient’s medical history is not feasible -- for example because of dementia or delirium -- then a chest x-ray is warranted, according to Sacha de Stoppelaar, MD, University of Amsterdam, Amsterdam, the Netherlands, and colleagues.

The findings were presented here at the 29th European Congress of Clinical Microbiology & Infectious Diseases (ECCMID).

For the study, the researchers prospectively analysed data from 741 adult patients presenting to a hospital’s emergency department over the course of 1 year. All patients were admitted due to suspected infection.

Suspicion of infection was defined as a body temperature of >38.0 degrees Celsius or 100 mg/L.

A total of 274 patients were excluded from the study because the source of infection was clearly non-pulmonary. The clinicians conducted a chest x-ray in the remaining 467 patients. Of these, 365 people had presented with respiratory symptoms, compared with 70 who did not have such symptoms, while another 32 had an unreliable medical history upon admission.

The results showed that chest x-ray helped diagnose pneumonia in 26.3% of the patients with respiratory symptoms and in 15.6% of the patients with an unreliable medical history, but not in any of the patients who had no respiratory symptoms.

“In contrast to international guidelines, our study shows that chest x-ray has no diagnostic value in patients with fever and no symptoms or signs of pneumonia -- if reliable medical history is possible,” the authors concluded.

[Presentation title: Diagnostic Value of Routine Chest X-Ray in Evaluation of Ambulant Adult Patients With Fever and No Respiratory Signs and Symptoms. Abstract P0475]