White blood cell count poor predictor of bacterial infection
Apr 18, 2014 5:10:39 GMT -5
slevittMD likes this
Post by drizsak on Apr 18, 2014 5:10:39 GMT -5
An article you really should READ!!!
White blood cell count poor predictor of bacterial infection in febrile children
Carla Kemp, Senior Editor
♦ De S, et al. Arch Dis Child. Jan. 9, 2014.
Total white blood cell and absolute neutrophil counts are not accurate triage tests for determining the likelihood of serious bacterial infection in febrile children, according to a prospective study of 3,893 children ages 0-5 years.
Physicians frequently order rapid lab tests to determine if fever in young children is due to a viral or bacterial infection. Clinical guidelines give specific white blood cell count thresholds to determine whether additional tests should be performed and antibiotics given. The American College of Emergency Physicians recommends consideration of antibiotic therapy if fever without a source is greater than 39 degrees Celsius (102.2 degrees Fahrenheit) and the total white blood cell count is 15X109/L or higher in previously healthy, well-appearing children ages 3-36 months.
Results of studies assessing the accuracy of total white blood cell and neutrophil counts in identifying bacterial infections have varied. In addition, most trials were done before the pneumococcal vaccine was used routinely.
Researchers conducted this study to determine if total white blood cell and neutrophil counts could be used to detect urinary tract infections, bacteremia and pneumonia in young children who presented to the emergency department with fever. Reference standards included culture positivity for urinary tract infection and bacteremia and radiological criteria for pneumonia.
Results showed serious bacterial infections were present in 18% of children. High white blood cell count had a sensitivity of 47%, specificity 76%, positive likelihood ratio 1.93 and negative likelihood ratio 0.70. A high absolute neutrophil count had a sensitivity of 41%, specificity of 78%, positive likelihood ratio 1.87 and negative likelihood ratio 0.75.
A white blood cell count threshold of 15X109/L missed half of serious infections and misclassified a quarter of self-limiting illnesses.
The authors concluded that the study results suggest that these tests should not be used routinely to guide management of otherwise healthy children with febrile illness.
White blood cell count poor predictor of bacterial infection in febrile children
Carla Kemp, Senior Editor
♦ De S, et al. Arch Dis Child. Jan. 9, 2014.
Total white blood cell and absolute neutrophil counts are not accurate triage tests for determining the likelihood of serious bacterial infection in febrile children, according to a prospective study of 3,893 children ages 0-5 years.
Physicians frequently order rapid lab tests to determine if fever in young children is due to a viral or bacterial infection. Clinical guidelines give specific white blood cell count thresholds to determine whether additional tests should be performed and antibiotics given. The American College of Emergency Physicians recommends consideration of antibiotic therapy if fever without a source is greater than 39 degrees Celsius (102.2 degrees Fahrenheit) and the total white blood cell count is 15X109/L or higher in previously healthy, well-appearing children ages 3-36 months.
Results of studies assessing the accuracy of total white blood cell and neutrophil counts in identifying bacterial infections have varied. In addition, most trials were done before the pneumococcal vaccine was used routinely.
Researchers conducted this study to determine if total white blood cell and neutrophil counts could be used to detect urinary tract infections, bacteremia and pneumonia in young children who presented to the emergency department with fever. Reference standards included culture positivity for urinary tract infection and bacteremia and radiological criteria for pneumonia.
Results showed serious bacterial infections were present in 18% of children. High white blood cell count had a sensitivity of 47%, specificity 76%, positive likelihood ratio 1.93 and negative likelihood ratio 0.70. A high absolute neutrophil count had a sensitivity of 41%, specificity of 78%, positive likelihood ratio 1.87 and negative likelihood ratio 0.75.
A white blood cell count threshold of 15X109/L missed half of serious infections and misclassified a quarter of self-limiting illnesses.
The authors concluded that the study results suggest that these tests should not be used routinely to guide management of otherwise healthy children with febrile illness.
