Identifying febrile young infants with bacteremia: Is the peripheral white blood cell count an accurate screen?

Bonsu, Bema K.; ChB, MB; Harper, Marvin B.

doi:10.1067/mem.2003.299

Cited by 89 publications

(60 citation statements)

References 34 publications

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“…21 The availability of a biomarker that could accurately and rapidly identify SBI in febrile infants and children without obvious source would frequently obviate the need for invasive procedures such as lumbar punctures and reduce the use of empirical antibiotics and hospitalization and would be of significant importance to patients, their families, and clinicians. Prior studies on the accuracy of PCT in screening febrile infants and children for SBI in the ED setting have revealed inconsistent results.…”

Section: Discussionmentioning

confidence: 99%

“…To minimize the risk of misdiagnosing a child who in fact has an SBI, many ED practitioners rely on published guidelines and screening diagnostic tests, including lumbar punctures, particularly in the youngest infants 90 days of age and younger. 1,21 Considerable debate exists in the evaluation of these infants, with much controversy regarding the published guidelines because: 1) studies pertaining to -LR = negative likelihood ratio; NPV = negative predictive value; PCT = procalcitonin; PPV = positive predictive value; SBI = serious bacterial infection; WBC = white blood cell. *All values above and below the cutoff points are considered as screening positive for SBI and screening negative for SBI, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

Mahajan

Grzybowski

Chen

et al. 2014

Academic Emergency Medicine

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Objectives: There is no perfectly sensitive or specific test for identifying young, febrile infants and children with occult serious bacterial infections (SBIs). Studies of procalcitonin (PCT), a 116-amino-acid precursor of the hormone calcitonin, have demonstrated its potential as an acute-phase biomarker for SBI. The objective of this study was to compare performance of serum PCT with traditional screening tests for detecting SBIs in young febrile infants and children.Methods: This was a prospective, multicenter study on a convenience sample from May 2004 to December 2005. The study was conducted in four emergency departments (EDs): one pediatric ED and three EDs with pediatric units, all with academic faculty on staff. A total of 226 febrile children 36 months old or younger who presented to the four participating EDs and were evaluated for SBI by blood, urine, and/or cerebral spinal fluid (CSF) cultures were included.Results: The test characteristics (with 95% confidence intervals [CIs]) of the white blood cell (WBC) counts including neutrophil and band counts were compared with PCT for identifying SBI. Thirty children had SBIs (13.3%, 95% CI = 8.85 to 17.70). Four (13.3%) had bacteremia (including one with meningitis), 18 (60.0%) had urinary tract infections (UTIs), and eight (26.6%) had pneumonia. Children with SBIs had higher WBC counts (18.6 9 10 9 AE 8.6 9 10 9 cells/L vs. 11.5 9 10 9 AE 5.3 9 10 9 cells/L, p < 0.001), higher absolute neutrophil counts (ANCs; 10.6 9 10 9 AE 6.7 9 10 9 cells/L vs. 5.6 9 10 9 AE 3.8 9 10 9 cells/L, p = 0.009), higher absolute band counts (0.90 9 10 9 AE 1.1 9 10 9 cells/L vs. 0.35 9 10 9 AE 0.6 9 10 9 cells/L, p = 0.009), and higher PCT levels (2.9 AE 5.6 ng/mL vs. 0.4 AE 0.8 ng/mL, p = 0.021) than those without SBIs. In a multivariable logistic regression analysis, the absolute band count and PCT were the two screening tests independently associated with SBI, although the area under the receiver operating characteristic (ROC) curve for PCT was the largest (0.80, 95% CI = 0.71 to 0.89).Conclusions: Procalcitonin is a more accurate biomarker than traditional screening tests for identifying young febrile infants and children with serious SBIs. Further study on a larger cohort of young febrile children is required to definitively determine the benefit of PCT over traditional laboratory screening tests for SBIs.ACADEMIC EMERGENCY MEDICINE 2014; 21:171-179

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

Mahajan

Grzybowski

Chen

et al. 2014

Academic Emergency Medicine

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“…18 However, due to the time lag in the response of CRP to infection, some clinicians use it in combination with other biomarkers.…”

Section: Bhavneet Bharti Et Al‗s Studymentioning

confidence: 99%

Yale Observation Score for Prediction of Critical Illness in 3-36 Months Old Febrile Children

2017

IJSR

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Introduction-Combining the laboratory tests with a pediatrician"s self-judgmental score is thought to aid in diagnosing serious illness. Yale Observation Scale is one such observational score studied worldwide. Study Design-Prospective, hospital based, cross-sectional study. Material and Methods-100 consecutive children 3-36 months of age with rectal temperature>101 F were enrolled and YOS scoring done. This was followed by physical examination and extensive laboratory testing with CBC, PBF, Urine and stool routine/microscopy, chest x-ray, CRP, ESR and blood cultures. The primary outcome was analysis of sensitivity, specificity, positive and negative predictive values of YOS scale in predicting critical illness while the secondary outcome was determination of vital parameters and laboratory findings which could reflect as "red flag " signs for critical illness. Results-YOS score of 10 on the ROC curve had 92.3 % Sensitivity, 44.2% Specificity, Positive Predictive Value (PPV) 51.4% and Negative Predictive Value (NPV) 90% for intensive care requirement as demonstrated by percentage PICU admissions while with respect to clinical outcome, it had a sensitivity of 100.0%, specificity of 32.9%, PPV 12.86% and NPV 100%. Mean heart rates and respiratory rates were statistically positive "red flags" while mean temperature elevation , TLC, ESR and CRP levels had negative results. Conclusion-YOS score is very useful in ruling out critical illness in 3-36 months age group at cut-off value of 10 while only significantly higher scores(>16) depict essentially serious illness and poorer outcome.

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“…C-reactive protein (CRP) and the leukocyte and neutrophil counts are the acute-phase reactants used most widely in children admitted to the emergency department with a high fever. (1)(2)(3) In the last 20 years, procalcitonin has been identified as a promising bacterial infection marker in children with fever. Also, CD 15s as a neutrophil surface molecule was reported a potentially valuable biomarker in infants with severe bacterial infection.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Eosinophil Count to C –reactive protein, Leukocyte Count, and Neutrophil Count for the detection of bacterial infection in ill-appearing children with fever admitted to the Emergency Department

Bal¹,

Anıl²,

Gökalp³

et al. 2015

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Identifying febrile young infants with bacteremia: Is the peripheral white blood cell count an accurate screen?

Cited by 89 publications

References 34 publications

Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

Yale Observation Score for Prediction of Critical Illness in 3-36 Months Old Febrile Children

Comparison of the Eosinophil Count to C –reactive protein, Leukocyte Count, and Neutrophil Count for the detection of bacterial infection in ill-appearing children with fever admitted to the Emergency Department

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