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The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study. | LitMetric

AI Article Synopsis

  • The study assesses the effectiveness of white blood cell count (WBC) in predicting serious bacterial infections (SBI) in children compared to C reactive protein (CRP) and absolute neutrophil count (ANC).
  • After analyzing data from over 17,000 febrile children across multiple European emergency departments, WBC showed poor predictive value with a sensitivity of 56% and specificity of 74% for WBC >15.
  • The findings suggest that CRP is a better marker for identifying SBI in children, and WBC should only be used for specific cases rather than as a routine diagnostic tool.

Article Abstract

Background: White blood cell count (WBC) is a widely used marker for the prediction of serious bacterial infection (SBI); however, previous research has shown poor performance. This study aims to assess the value of WBC in the prediction of SBI in children at the emergency department (ED) and compare its value with C reactive protein (CRP) and absolute neutrophil count (ANC).

Methods: This study is an observational multicentre study including febrile children aged 0-18 years attending 1 of 12 EDs in 8 European countries. The association between WBC and SBI was assessed by multivariable logistic regression, adjusting for age, CRP and duration of fever. Additionally, diagnostic performance was assessed by sensitivity and specificity. Results were compared with CRP and ANC.

Results: We included 17 082 children with WBC measurements, of which 1854 (10.9%) had an SBI. WBC >15 had an adjusted OR of 1.9 (95% CI 1.7 to 2.1) for prediction of SBI, after adjusting for confounders. Sensitivity and specificity were 0.56 (95% CI 0.54 to 0.58) and 0.74 (0.73 to 0.75) for WBC >15, and 0.32 (0.30 to 0.34) and 0.91 (0.91 to 0.91) for WBC >20, respectively. In comparison, CRP >20 mg/L had a sensitivity of 0.87 (95% CI 0.85 to 0.88) and a specificity of 0.59 (0.58 to 059). For CRP >80 mg/L, the sensitivity was 0.55 (95% CI 0.52 to 057) and the specificity was 0.91 (0.90 to 0.91). Additionally, for ANC >10, the sensitivity was 0.55 (95% CI 0.53 to 0.58) and the specificity was 0.75 (0.75 to 0.76). The combination of WBC and CRP did not improve performance compared with CRP alone.

Conclusion: WBC does not have diagnostic benefit in identifying children with an SBI compared with CRP and should only be measured for specific indications.

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Source
http://dx.doi.org/10.1136/archdischild-2024-327493DOI Listing

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