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Extreme leucocytosis and the risk of serious bacterial infections in febrile children
  1. Michal Brauner1,
  2. Michael Goldman1,2,
  3. Eran Kozer2,3
  1. 1Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel
  2. 2Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin, Israel
  1. Correspondence to Eran Kozer, Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel; erank{at}asaf.health.gov.il

Abstract

Objective To determine the clinical significance of extreme leucocytosis (white blood cell (WBC) count >25 000/mm3) 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°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/mm3 (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.

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Footnotes

  • Competing interests None.

  • Ethics approval The hospital ethics board approved the study protocol. Provenance and peer review Not commissioned; not externally peer reviewed.

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