Author(s): Brauner M, Goldman M, Kozer E, Brauner M, Goldman M, Kozer E
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Abstract OBJECTIVE: To determine the clinical significance of extreme leucocytosis (white blood cell (WBC) count >25,000/mm(3)) as a predictor of serious bacterial infection (SBI) in children. PATIENTS AND METHODS: A retrospective case-control study was conducted in a paediatric emergency department in Israel. The study evaluated children aged 3-36 months admitted to the emergency department with fever (>38 degrees C) who had a complete blood count (CBC). Children with extreme leucocytosis were identified through the laboratory database. Further, for each case patient two consecutive febrile patients with WBC counts of 15,000-24,999/mm(3) (moderate leucocytosis) served as controls (a case-control ratio of 1:2). RESULTS: During the study, 146 patients with extreme leucocytosis were identified and compared with 292 patients with moderate leucocytosis. SBI was found in 57 (39\%) patients with extreme leucocytosis compared with 45 (15.4\%) control patients (p<0.001). The most commonly found SBI was segmental or lobar pneumonia, which was diagnosed in 41 (28\%) patients in the case group compared with 27 (9.2\%) patients in the control group (p<0.001, OR 3.83, 95\% CI 2.25 to 6.52). Children with extreme leucocytosis were more often treated with antibiotics (52.7\% vs 27.7\%, p<0.001) and admitted to hospital (98.6\% vs 50.68\%, p<0.001). CONCLUSIONS: In febrile children aged 3-36 months, the presence of extreme leucocytosis is associated with a 39\% risk of having SBIs. The increased risk for SBI is mainly due to a higher risk for pneumonia.
This article was published in Arch Dis Child
and referenced in Journal of Medical Diagnostic Methods