Clinical Impact of Sinus CT Surveillance Imaging among Febrile Neutropenic Patients: A Retrospective Observational Study

BACKGROUND AND PURPOSE: At many institutions, CT imaging is routinely performed among febrile neutropenic patients to identify fever sources. We examined the impact of surveillance sinus CT imaging results on the clinical management of febrile neutropenic patients with hematologic disorders undergoing chemotherapy or bone marrow transplant.

MATERIALS AND METHODS: Following internal review board approval, we identified consecutive CT sinus examinations performed among patients with febrile neutropenia in the setting of chemotherapy or bone marrow transplant for hematologic malignancy and other hematologic disorders between January and March of 2017. CT sinus reports were reviewed for the presence or absence of sinus inflammatory changes. Electronic medical records (EMRs) for each patient at the time of each scan were reviewed for clinical parameters, including type of hematologic malignancy or hematologic disorder, treatment approach, fever >100.4F, absolute neutrophil count <1500 cells/μL, and presence of clinical features of sinusitis. EMRs were reviewed for any changes in antibiotic coverage on the basis of scan results, whether positive or negative, along with results of cultures, if performed. Clinical notes from hematology-oncology specialists as well as infectious disease and otolaryngology consultants, if performed, were also reviewed. Results were tabulated and recorded.

RESULTS: Of 127 CT sinus scans performed on 87 patients, including 41 males and 46 females, with a mean age of 54 ± 18 years, 15 (11.8%) reported imaging findings of acute sinusitis, while the remaining 112 (88.2%) showed no suspicious imaging features of acute sinus inflammation. Of 15 scans with evidence of acute sinusitis, 4 coincided with a change in antimicrobial management based on clinical, not imaging, findings. Of the 112 scans without imaging findings of acute sinusitis, 18 coincided with a change in antimicrobial management based on clinical concerns and/or imaging evidence of infection outside the sinonasal cavity. Of the 87 patients scanned, thirty (34%) had multiple examinations during the investigated 3-month period.

CONCLUSIONS: CT sinus imaging results, positive or negative, did not directly alter clinical management in this patient population. Appropriate value-based imaging in this vulnerable population is an evolving concept; however, current results suggest routine sinus CT may be a low-yield examination in the setting of febrile neutropenia.