Introduction: The presence of band cells > 10% of the total white blood cell (WBC) count (“bandemia”) is often used as an indicator of serious bacterial illness (SBI). Results from studies of bandemia as a predictor of SBI were conflicting and little is known about the relationship between severe bandemia (SB) and clinical outcomes from SBI in children. We hypothesized that SB (band level > 20%) is not associated with adverse outcomes in an emergency department (ED) pediatric population. Methods: Medical records from children between the ages of two months and 18 years with SB who presented to a tertiary referral regional hospital were studied. Outcomes were categorized as severe adverse events (SAEs) or moderate adverse events (MAEs). Multivariate logistic regressions were used to assess the association between SB and outcomes. Results: We analyzed 102 patients. Mean age (standard deviation, SD) was 5.25 (0.5) years, 18 (18%) had MAE, 21 (21%) had SAE, and no patients died. Mean band levels were similar between groups: no adverse events 28 (10) vs. SAE 31 (9) vs. MAE 27 (8), p=0.64. Multivariate logistic regressions showed SB was not associated with any adverse events (odds ratio (OR) 1.04, 95% confidence interval (CI) 0.9-1.1, p=0.27). Non-normal X-ray (XR) (OR 17, 95% CI 3.3-90, p<0.001) was associated with MAE, while non-normal computerized tomography (CT) scan (OR 15.4, 95% CI 2.2-100+, p=0.002) was associated with SAE. Conclusion: SB was not associated with higher odds of adverse events among the general ED pediatric population. Clinicians should base their clinical judgment on the overall context of history, physical examinations, and other laboratory and imaging data.
BackgroundTimely intervention is essential for the successful removal of ingested foreign bodies. Emergent endoscopy (EGD) is usually performed in the emergency department (ED), operating room (OR), intensive care unit (ICU), or endoscopy suite. However, because the endoscopy suite is not always available, this study investigated the impact of location outside of the endoscopy suite on the successful removal of ingested foreign bodies and other patient outcomes. MethodologyWe reviewed charts of patients who underwent EGD for foreign body removal at an academic quaternary center between January 01, 2012, and December 31, 2020. We defined successful EGD as retrieval of the foreign body at the first attempt and not requiring subsequent endoscopy or surgical intervention. We performed descriptive and inferential statistical analyses and conducted classification and regression trees to compare endoscopy procedure length (EPL) and hospital length of stay (HLOS) between different locations. ResultsWe analyzed 77 patients, of whom 13 (17%) underwent endoscopy in the ICU, 46 (60%) in the OR, and 18 (23%) in the ED. Endoscopic removal failed in four (5%) patients. Endoscopy length was significantly shorter in the OR (67 (48-122) minutes) versus the ICU (158 (95-166) minutes, P = 0.004) and the ED (111 (92-155) minutes, P = 0.009). Time to procedure was similar if the procedure was performed in the ED (278 minutes), the ICU (331 minutes), or the OR (378 minutes). The median (interquartile range) of HLOS for the OR group (0.87 (0.54-2.03) days) was significantly shorter than the ICU group (2.26 (1.47-6.91) days, P = 0.007). ConclusionsWhile performing endoscopy for esophageal foreign body removal in the OR may be associated with a shorter EPL and HLOS, no location was inferior for overall outcomes. Further prospective and randomized studies are needed to confirm our findings.
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