Laboratory Tests in Evaluation of Acute Febrile Illness in Pediatric Emergency Room Patients

Abstract

The rising costs of health care and the movement for health care reform have focused attention on methods of cost containment. Of routine laboratory and radiologic procedures, complete blood cell count (CBC) and determination of serum electrolyte values rank as high as 2nd and 9th in overall cost. We retrospectively studied use of the clinical laboratory to aid diagnosis of an acute infectious event in a pediatric emergency department population.For 5 months, we reviewed medical records of pediatric patients younger than 15 years brought to the emergency department because of a febrile episode. Of 155 cases reviewed, electrolyte concentrations were determined in 108 patients and CBC in 155. In all patients, either culture or rapid test for streptococcal organisms was performed. In addition, 838 pediatric patients with similar symptoms but who did not undergo laboratory testing were monitored for 100 days. Measures of effectiveness including sensitivity, specificity, positive and negative predictive values, and likelihood ratio were used to correlate specific laboratory findings with antibiotic therapy, serious bacterial disease, and culture positivity.Electrolyte abnormalities were found largely to be dismissed clinically, with the major clinical response consisting of parental education about hydration. The CBC profile was evaluated, with white blood cell count (WBC) indicator limits of >10,000, >10,000 but <15,000, and >15,000/mm 3 , and differentiated into absoluteThe rising costs of health care and calls for health care reform have focused attention on methods of cost containment. 1-8 Standards of care have been promulgated for specific clinical situations, in the hope of eliminating unnecessary laboratory testing and decreasing the use of tests with low yield, without compromise of patient care.9-11 Use and overuse of

Mean cell volumes of neutrophils and monocytes are promising markers of sepsis in elderly patients

“…Furthermore, procalcitonin levels distinguish bacterial from viral infections, correlate well with clinical severity [6, 7], and show higher predictive sensitivity than CRP [8]. Blood culture remains the gold standard for diagnosing septicemia; however, this method shows low sensitivity [9], requires an adequate amount of blood and proper collection techniques to avoid contamination, and can delay diagnosis as the results may require several days.…”

Impact of blood testing on patient disposition from the emergency department

“…The relative impact of blood tests has been studied on select populations but not in the general ED population. White cell counts to determine surgery for patients with right‐sided abdominal pain, electrolytes in children with suspected bacteraemia or routine screening in mental illness are examples where routine testing has been demonstrated to have little impact on interventions or outcomes 4–6 . Although the results of some blood tests may impact on therapy, either in the ED or on the ward, it is not clear that these results will change disposition.…”

“…White cell counts to determine surgery for patients with right-sided abdominal pain, electrolytes in children with suspected bacteraemia or routine screening in mental illness are examples where routine testing has been demonstrated to have little impact on interventions or outcomes. [4][5][6] Although the results of some blood tests may impact on therapy, either in the ED or on the ward, it is not clear that Correspondence these results will change disposition. In particular, if disposition can be determined quickly, after the initial history and examination, then it will provide an earlier opportunity to notify in-patient units, allocate beds or plan the return of a patient to home.…”

Comparative Practice Patterns of Emergency Medicine Physicians and Pediatric Emergency Medicine Physicians Managing Fever in Young Children

“…Although several reports have commented on the different management approaches between community-based and hospital-based practitioners, the majority of these studies were based on the surveyed responses of groups of physicians. [1][2][3][4][5] Few studies have evaluated actual practice patterns to compare and contrast management styles.…”