Value of routine chest radiography in the diagnostic work-up of ill returned travelers

Background: Respiratory tract infections frequently occur in ill returned travelers, a minority of whom present with pneumonia. The most accurate and cost-effective diagnostic work-up remains an area of uncertainty. In this retrospective cohort study, the utility of routine chest radiography was evaluated. Methods: This study was performed at the Institute for Tropical Diseases in Rotterdam and included all returned travelers in the period between 2007 and 2009 that were ill with symptoms lasting less than 1 month and had chest radiography on admission. Travelers' demographic (including travel history), clinical, and laboratory data were collected on admission and evaluated for their diagnostic power to predict radiographic evidence of a pulmonary infiltrate. Results: Fifty-three (7%) of 750 ill returned travelers had radiographic evidence of a pulmonary infiltrate. Presentation with cough (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.46-5.38), or elevated C-reactive protein values (OR 1.13, 95% CI 1.09-1.17), and white blood cell count (OR 1.08, 95% CI 1.05-1.17) strongly correlated with the presence of a pulmonary infiltrate. Recursive partitioning analysis identified a subset of 384 patients presenting with both cough and fever, or C-reactive protein values in excess of 23 mg/L that would optimally benefit from chest radiography. Conclusion: The results of this study indicate that a more judicious use of chest radiography in the routine work-up of ill returned travelers is warranted.