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

Kemps, N.; Vermont, C.; Tan, C. D.; von Both, U.; Carrol, E.; Emonts, M.; van der Flier, M.; Herberg, J. A.; Kohlmaier, B.; Levin, M.; Lim, E.; Maconochie, I.; Martinón-Torres, F.; Nijman, R.; Pokorn, M.; Rivero-Calle, I.; Rudzāte, A.; Tsolia, M.; Zavadska, D.; Zenz, W.; Moll, H. A.; Zachariasse, J. M.; Cunnington, A.; De, T.; Kaforou, M.; Wright, V.; Baumard, L.; Bellos, E.; D’Souza, G.; Galassini, R.; Habgood-Coote, D.; Hamilton, S.; Hoggart, C.; Hourmat, S.; Jackson, H.; Menikou, S.; Lin, N.; Nichols, S.; Paz, I. P.; Shah, P.; Shen, C. F.; Vito, O.; Wilson, C.; Abdulla, A.; Ali, L.; Darnell, S.; Jorgensen, R.; Mustafa, S.; Persand, S.; Stevens, M.; Kim, E.; Pierce, B.; Fidler, K.; Dudley, J.; Richmond, V.; Tavliavini, E.; Liu, C. C.; Wang, S. M.; Álvez González, F.; Balo Farto, C.; Barral-Arca, R.; Barreiro Castro, M.; Bello, X.; Ben García, M.; Carnota, S.; Cebey-López, M.; Curras-Tuala, M. J.; Durán Suárez, C.; García Vicente, L.; Gómez-Carballa, A.; Gómez Rial, J.; Leboráns Iglesias, P.; Martinón-Torres, N.; Martinón Sánchez, J. M.; Mosquera Pérez, B.; Pardo-Seco, J.; Piñeiro Rodríguez, L.; Pischedda, S.; Rey Vázquez, S.; Rivero Calle, I.; Rodríguez-Tenreiro, C.; Redondo-Collazo, L.; Sadiki Ora, M.; Salas, A.; Serén Fernández, S.; Serén Trasorras, C.; Vilas Iglesias, M.; Balode, A.; Bārzdiņa, A.; Deksne, D.; Gardovska, D.; Grāvele, D.; Grope, I.; Meiere, A.; Nokalna, I.; Pavāre, J.; Pučuka, Z.; Selecka, K.; Sidorova, A.; Svile, D.; Urbāne, U. N.; Usuf, E.; Bojang, K.; Zaman, S. M. A.; Secka, F.; Anderson, S.; Sarr, A. R.; Saidykhan, M.; Darboe, S.; Ceesay, S.; D’alessandro, U.; Borensztajn, D. M.; Hagedoorn, N. N.; Tan, C.; Vermont, C. L.; Zachariasse, J.; Dik, W.; Christoph, Aebi; Wyss, V.; Usman, M.; Agyeman, P.; Schlapbach, L. J.; Giannoni, E.; Stocker, M.; Posfay-Barbe, K. M.; Heininger, U.; Bernhard-Stirnemann, S.; Niederer-Loher, A.; Kahlert, C.; Natalucci, G.; Relly, C.; Riedel, T.; Aebi, C.; Berger, C.; Carrol, E. D.; Paulus, S.; Cocklin, E.; Jennings, R.; Johnston, J.; Leigh, S.; Newall, K.; Romaine, S.; Eleftheriou, I.; Tambouratzi, M.; Marmarinos, A.; Xagorari, M.; Syggelou, K.; Fink, C.; Voice, M.; Calvo-Bado, L.; Schweintzger, N. A.; Sagmeister, M. G.; Kohlfürst, D. S.; Zurl, C.; Binder, A.; Hösele, S.; Leitner, M.; Pölz, L.; Rajic, G.; Bauchinger, S.; Baumgart, H.; Benesch, M.; Ceolotto, A.; Eber, E.; Gallistl, S.; Gores, G.; Haidl, H.; Hauer, A.; Hude, C.; Keldorfer, M.; Krenn, L.; Pilch, H.; Pfleger, A.; Pfurtscheller, K.; Nordberg, G.; Niedrist, T.; Rödl, S.; Skrabl-Baumgartner, A.; Sperl, M.; Stampfer, L.; Strenger, V.; Till, H.; Trobisch, A.; Löffler, S.; Yeung, S.; Dewez, J. E.; Hibberd, M.; Bath, D.; Miners, A.; Wedderburn, C.; Meierford, A.; Leurent, B.; de Groot, R.; de Jonge, M. I.; van Aerde, K.; Alkema, W.; van den Broek, B.; Gloerich, J.; van Gool, A. J.; Henriet, S.; Huijnen, M.; Philipsen, R.; Willems, E.; Gerrits, G. P. J. M.; van Leur, M.; Heidema, J.; de Haan, L.; Miedema, C. J.; Neeleman, C.; Obihara, C. C.; Tramper-Stranders, G. A.; Pollard, A. J.; Kandasamy, R.; Carter, M. J.; O'Connor, D.; Bibi, S.; Kelly, D. F.; Gurung, M.; Thorson, S.; Ansari, I.; Murdoch, D. R.; Shrestha, S.; Oliver, Z.; Valentine, L.; Allen, K.; Bell, K.; Chan, A.; Crulley, S.; Devine, K.; Fabian, D.; King, S.; McAlinden, P.; McDonald, S.; McDonnell, A.; Pickering, A.; Thomson, E.; Wood, A.; Wallia, D.; Woodsford, P.; Baxter, F.; Bell, A.; Rhodes, M.; Agbeko, R.; Mackerness, C.; Baas, B.; Kloosterhuis, L.; Oosthoek, W.; Arif, T.; Bennet, J.; Collings, K.; van der Giessen, I.; Martin, A.; Rashid, A.; Rowlands, E.; de Vries, G.; van der Velden, F.; Martin, M.; Mistry, R.; Kolberg, L.; Zwerenz, M.; Buschbeck, J.; Bidlingmaier, C.; Binder, V.; Danhauser, K.; Haas, N.; Griese, M.; Feuchtinger, T.; Keil, J.; Kappler, M.; Lurz, E.; Muench, G.; Reiter, K.; Schoen, C.; Mallet, F.; Brengel-Pesce, K.; Pachot, A.; Mommert, M.; Kolnik, M.; Vincek, K.; Srovin, T. P.; Bahovec, N.; Prunk, P.; Osterman, V.; Avramoska, T.; Kuijpers, T.; Jongerius, I.; van den Berg, J. M.; Schonenberg, D.; Barendregt, A. M.; Pajkrt, D.; van der Kuip, M.; van Furth, A. M.; Sprenkeler, E.; Zandstra, J.; van Mierlo, G.; Geissler, J.

Please use this identifier to cite or link to this item: https://dora.health.qld.gov.au/qldresearchjspui/handle/1/12335

Title:	The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study
Authors:	Kemps, N.;Vermont, C.;Tan, C. D.;von Both, U.;Carrol, E.;Emonts, M.;van der Flier, M.;Herberg, J. A.;Kohlmaier, B.;Levin, M.;Lim, E.;Maconochie, I.;Martinón-Torres, F.;Nijman, R.;Pokorn, M.;Rivero-Calle, I.;Rudzāte, A.;Tsolia, M.;Zavadska, D.;Zenz, W.;Moll, H. A.;Zachariasse, J. M.;Cunnington, A.;De, T. ;Kaforou, M.;Wright, V.;Baumard, L.;Bellos, E.;D’Souza, G.;Galassini, R.;Habgood-Coote, D.;Hamilton, S. ;Hoggart, C.;Hourmat, S.;Jackson, H.;Menikou, S.;Lin, N.;Nichols, S. ;Paz, I. P.;Shah, P.;Shen, C. F.;Vito, O.;Wilson, C.;Abdulla, A.;Ali, L.;Darnell, S.;Jorgensen, R.;Mustafa, S.;Persand, S.;Stevens, M.;Kim, E.;Pierce, B.;Fidler, K.;Dudley, J.;Richmond, V.;Tavliavini, E.;Liu, C. C.;Wang, S. M.;Álvez González, F.;Balo Farto, C.;Barral-Arca, R.;Barreiro Castro, M.;Bello, X.;Ben García, M.;Carnota, S.;Cebey-López, M.;Curras-Tuala, M. J.;Durán Suárez, C.;García Vicente, L.;Gómez-Carballa, A.;Gómez Rial, J.;Leboráns Iglesias, P.;Martinón-Torres, N.;Martinón Sánchez, J. M.;Mosquera Pérez, B.;Pardo-Seco, J.;Piñeiro Rodríguez, L.;Pischedda, S.;Rey Vázquez, S.;Rivero Calle, I.;Rodríguez-Tenreiro, C.;Redondo-Collazo, L.;Sadiki Ora, M.;Salas, A.;Serén Fernández, S.;Serén Trasorras, C.;Vilas Iglesias, M.;Balode, A.;Bārzdiņa, A.;Deksne, D.;Gardovska, D.;Grāvele, D.;Grope, I.;Meiere, A.;Nokalna, I.;Pavāre, J.;Pučuka, Z.;Selecka, K.;Sidorova, A.;Svile, D.;Urbāne, U. N.;Usuf, E.;Bojang, K.;Zaman, S. M. A.;Secka, F.;Anderson, S. ;Sarr, A. R.;Saidykhan, M.;Darboe, S.;Ceesay, S.;D’alessandro, U.;Borensztajn, D. M.;Hagedoorn, N. N.;Tan, C.;Vermont, C. L.;Zachariasse, J.;Dik, W.;Christoph, Aebi;Wyss, V.;Usman, M.;Agyeman, P.;Schlapbach, L. J.;Giannoni, E.;Stocker, M.;Posfay-Barbe, K. M.;Heininger, U.;Bernhard-Stirnemann, S.;Niederer-Loher, A.;Kahlert, C.;Natalucci, G.;Relly, C.;Riedel, T.;Aebi, C.;Berger, C.;Carrol, E. D.;Paulus, S.;Cocklin, E.;Jennings, R.;Johnston, J.;Leigh, S. ;Newall, K.;Romaine, S.;Eleftheriou, I.;Tambouratzi, M.;Marmarinos, A.;Xagorari, M.;Syggelou, K.;Fink, C.;Voice, M.;Calvo-Bado, L.;Schweintzger, N. A.;Sagmeister, M. G.;Kohlfürst, D. S.;Zurl, C.;Binder, A.;Hösele, S.;Leitner, M.;Pölz, L.;Rajic, G.;Bauchinger, S.;Baumgart, H.;Benesch, M.;Ceolotto, A.;Eber, E.;Gallistl, S.;Gores, G.;Haidl, H.;Hauer, A.;Hude, C.;Keldorfer, M.;Krenn, L.;Pilch, H.;Pfleger, A.;Pfurtscheller, K.;Nordberg, G.;Niedrist, T.;Rödl, S.;Skrabl-Baumgartner, A.;Sperl, M.;Stampfer, L.;Strenger, V.;Till, H.;Trobisch, A.;Löffler, S.;Yeung, S.;Dewez, J. E.;Hibberd, M.;Bath, D.;Miners, A.;Wedderburn, C.;Meierford, A.;Leurent, B.;de Groot, R.;de Jonge, M. I.;van Aerde, K.;Alkema, W.;van den Broek, B.;Gloerich, J.;van Gool, A. J.;Henriet, S.;Huijnen, M.;Philipsen, R.;Willems, E.;Gerrits, G. P. J. M.;van Leur, M.;Heidema, J.;de Haan, L.;Miedema, C. J.;Neeleman, C.;Obihara, C. C.;Tramper-Stranders, G. A.;Pollard, A. J.;Kandasamy, R.;Carter, M. J.;O'Connor, D.;Bibi, S.;Kelly, D. F.;Gurung, M.;Thorson, S.;Ansari, I.;Murdoch, D. R.;Shrestha, S. ;Oliver, Z.;Valentine, L.;Allen, K.;Bell, K.;Chan, A.;Crulley, S.;Devine, K.;Fabian, D.;King, S. ;McAlinden, P.;McDonald, S. ;McDonnell, A.;Pickering, A.;Thomson, E.;Wood, A.;Wallia, D.;Woodsford, P.;Baxter, F.;Bell, A.;Rhodes, M.;Agbeko, R.;Mackerness, C.;Baas, B.;Kloosterhuis, L.;Oosthoek, W.;Arif, T.;Bennet, J.;Collings, K.;van der Giessen, I.;Martin, A.;Rashid, A.;Rowlands, E.;de Vries, G.;van der Velden, F.;Martin, M.;Mistry, R.;Kolberg, L.;Zwerenz, M.;Buschbeck, J.;Bidlingmaier, C.;Binder, V.;Danhauser, K.;Haas, N.;Griese, M.;Feuchtinger, T.;Keil, J.;Kappler, M.;Lurz, E.;Muench, G.;Reiter, K.;Schoen, C.;Mallet, F.;Brengel-Pesce, K.;Pachot, A.;Mommert, M.;Kolnik, M.;Vincek, K.;Srovin, T. P.;Bahovec, N.;Prunk, P.;Osterman, V.;Avramoska, T.;Kuijpers, T.;Jongerius, I.;van den Berg, J. M.;Schonenberg, D.;Barendregt, A. M.;Pajkrt, D.;van der Kuip, M.;van Furth, A. M.;Sprenkeler, E.;Zandstra, J.;van Mierlo, G.;Geissler, J.
Issue Date:	2025
Source:	Archives of Disease in Childhood, 2025 (110) 3 p.191-196
Pages:	191-196
Journal Title:	Archives of Disease in Childhood
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.
DOI:	10.1136/archdischild-2024-327493
Resources:	https://www.embase.com/search/results?subaction=viewrecord&id=L2034792221&from=export http://dx.doi.org/10.1136/archdischild-2024-327493
Type:	Article
Appears in Sites:	Children's Health Queensland Publications Queensland Health Publications

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