Invasive diagnostic procedures for pulmonary infiltrates in pediatric hematopoietic stem cell transplant recipients
- 1 November 2007
- journal article
- Published by Wiley in Pediatric Transplantation
- Vol. 11 (7), 736-742
- https://doi.org/10.1111/j.1399-3046.2007.00733.x
Abstract
To evaluate the role of BAL, CTB, and OLB in the management of pulmonary infiltrates in pediatric HSCT recipients, we conducted a retrospective review of clinical records of pediatric HSCT recipients. Data were analyzed using Chi-square for dichotomous and anova for continuous variables. Logistic regression was used to adjust confounding variables for diagnostic yield. Forty patients underwent 44 separate procedures. Infections were the prevailing cause of infiltrates with a positive diagnostic yield (96%). CTB and OLB were performed more often in patients with focal infiltrates compared with BAL (100%, 71% vs. 22%; p < 0.01). Adverse events were not significantly different across the three procedures. OLB more often yielded information that led to change in medical management (71% vs. 0%, 34%; p < 0.05) compared with CTB and BAL. Patients who had a positive diagnostic yield had no apparent survival advantage when compared with those in whom a procedure yielded no information. Logistic regression demonstrated that focal infiltrate was the only independently predictive variable for identifying a cause of pulmonary infiltrate. In conclusion, all three invasive diagnostic procedures were safe. Having a focal infiltrate was independently and significantly associated with having a positive diagnostic yield.Keywords
This publication has 42 references indexed in Scilit:
- Evaluation of persistent pulmonary infiltrates in pediatric oncology patientsPediatric Blood & Cancer, 2006
- Simplified PRISM III score and outcome in the pediatric intensive care unitPediatrics International, 2005
- Natural history of pulmonary complications in children after bone marrow transplantationTransplantation and Cellular Therapy, 2005
- Pulmonary Nodular Lesions in Bone Marrow Transplant RecipientsAmerican Journal of Clinical Pathology, 2004
- Pulmonary complications following bone marrow transplantationThe British Journal of Radiology, 2003
- Use of first line bronchoalveolar lavage in the immunosuppressed oncology patientBone Marrow Transplantation, 2001
- Introduction of the oncological pediatric risk of mortality score (O-PRISM) for ICU support following stem cell transplantation in childrenBone Marrow Transplantation, 2000
- Investigation and management of pulmonary infiltrates following bone marrow transplantation: an eight year review.Thorax, 1993
- BIOPSY DIAGNOSIS AND CLINICAL OUTCOME OF PERSISTENT FOCAL PULMONARY LESIONS AFTER MARROW TRANSPLANTATIONTransplantation, 1989
- The usefulness of open-lung biopsy in the pediatric bone marrow transplant populationJournal of Pediatric Surgery, 1988