Value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age

De, S; Williams, GJ; Hayen, A; Macaskill, P; McCaskill, M; Isaacs, D; Craig, JC

Value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age

De, S Williams, GJ Hayen, A

Macaskill, P McCaskill, M Isaacs, D Craig, JC

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Publication Type:: Journal Article
Citation:: Archives of Disease in Childhood, 2014, 99 (6), pp. 493 - 499
Issue Date:: 2014-01-01

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Field	Value	Language
dc.contributor.author	De, S	en_US
dc.contributor.author	Williams, GJ	en_US
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030	en_US
dc.contributor.author	Macaskill, P	en_US
dc.contributor.author	McCaskill, M	en_US
dc.contributor.author	Isaacs, D	en_US
dc.contributor.author	Craig, JC	en_US
dc.date.issued	2014-01-01	en_US
dc.identifier.citation	Archives of Disease in Childhood, 2014, 99 (6), pp. 493 - 499	en_US
dc.identifier.issn	0003-9888	en_US
dc.identifier.uri	http://hdl.handle.net/10453/118255
dc.description.abstract	Objective: The leukocyte count is frequently used to evaluate suspected bacterial infections but estimates of its test performance vary considerably. We evaluated its accuracy for the detection of serious bacterial infections in febrile children. Design: Prospective cohort study. Setting: Paediatric emergency department. Patients: Febrile 0-5-year-olds who had a leukocyte count on presentation. Outcome measures: Accuracy of total white blood cell and absolute neutrophil counts for the detection of urinary tract infection, bacteraemia, pneumonia and a combined ('any serious bacterial infection') category. Logistic regression models were fitted for each outcome. Reference standards were microbiological/radiological tests and clinical follow-up. Results: Serious bacterial infections were present in 714 (18.3%) of 3893 illness episodes. The area under the receiver operating characteristic curve for 'any serious bacterial infection' was 0.653 (95% CI 0.630 to 0.676) for the total white blood cell count and 0.638 (95% CI 0.615 to 0.662) for absolute neutrophil count. A white blood cell count threshold >15×10 9/L had a sensitivity of 47% (95% CI 43% to 50%), specificity 76% (95% CI 74% to 77%), positive likelihood ratio 1.93 (95% CI 1.75 to 2.13) and negative likelihood ratio 0.70 (95% CI 0.65 to 0.75). An absolute neutrophil count threshold >10×109/L had a sensitivity of 41% (95% CI 38% to 45%), specificity 78% (95% CI 76% to 79%), positive likelihood ratio 1.87 (95% CI 1.68 to 2.09) and negative likelihood ratio 0.75 (95% CI 0.71 to 0.80). Conclusions: The total white blood cell count and absolute neutrophil count are not sufficiently accurate triage tests for febrile children with suspected serious bacterial infection.	en_US
dc.relation.ispartof	Archives of Disease in Childhood	en_US
dc.relation.isbasedon	10.1136/archdischild-2013-304754	en_US
dc.subject.classification	Pediatrics	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Bacterial Infections	en_US
dc.subject.mesh	Fever	en_US
dc.subject.mesh	Leukocyte Count	en_US
dc.subject.mesh	Logistic Models	en_US
dc.subject.mesh	Sensitivity and Specificity	en_US
dc.subject.mesh	Cohort Studies	en_US
dc.subject.mesh	Follow-Up Studies	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	ROC Curve	en_US
dc.subject.mesh	Child, Preschool	en_US
dc.subject.mesh	Infant	en_US
dc.subject.mesh	Emergency Service, Hospital	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.title	Value of white cell count in predicting serious bacterial infection in febrile children under 5 years of age	en_US
dc.type	Journal Article
utslib.citation.volume	6	en_US
utslib.citation.volume	99	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1114 Paediatrics and Reproductive Medicine	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access
pubs.issue	6	en_US
pubs.publication-status	Published	en_US
pubs.volume	99	en_US

Abstract:

Objective: The leukocyte count is frequently used to evaluate suspected bacterial infections but estimates of its test performance vary considerably. We evaluated its accuracy for the detection of serious bacterial infections in febrile children. Design: Prospective cohort study. Setting: Paediatric emergency department. Patients: Febrile 0-5-year-olds who had a leukocyte count on presentation. Outcome measures: Accuracy of total white blood cell and absolute neutrophil counts for the detection of urinary tract infection, bacteraemia, pneumonia and a combined ('any serious bacterial infection') category. Logistic regression models were fitted for each outcome. Reference standards were microbiological/radiological tests and clinical follow-up. Results: Serious bacterial infections were present in 714 (18.3%) of 3893 illness episodes. The area under the receiver operating characteristic curve for 'any serious bacterial infection' was 0.653 (95% CI 0.630 to 0.676) for the total white blood cell count and 0.638 (95% CI 0.615 to 0.662) for absolute neutrophil count. A white blood cell count threshold >15×10 9/L had a sensitivity of 47% (95% CI 43% to 50%), specificity 76% (95% CI 74% to 77%), positive likelihood ratio 1.93 (95% CI 1.75 to 2.13) and negative likelihood ratio 0.70 (95% CI 0.65 to 0.75). An absolute neutrophil count threshold >10×109/L had a sensitivity of 41% (95% CI 38% to 45%), specificity 78% (95% CI 76% to 79%), positive likelihood ratio 1.87 (95% CI 1.68 to 2.09) and negative likelihood ratio 0.75 (95% CI 0.71 to 0.80). Conclusions: The total white blood cell count and absolute neutrophil count are not sufficiently accurate triage tests for febrile children with suspected serious bacterial infection.

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http://hdl.handle.net/10453/118255