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Original research
The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study
  1. Naomi Kemps1,
  2. Clementien Vermont2,
  3. Chantal D Tan1,
  4. Ulrich von Both3,4,
  5. Enitan Carrol5,6,
  6. Marieke Emonts7,8,9,
  7. Michiel van der Flier10,11,
  8. Jethro Adam Herberg12,
  9. Benno Kohlmaier13,
  10. Michael Levin12,
  11. Emma Lim7,14,
  12. Ian Maconochie15,
  13. Federico Martinón-Torres16,
  14. Ruud Gerard Nijman12,
  15. Marko Pokorn17,
  16. Irene Rivero-Calle16,
  17. Aleksandra Rudzāte18,
  18. Maria Tsolia19,
  19. Dace Zavadska18,
  20. Werner Zenz13,
  21. Henriette A Moll1,
  22. Joany M Zachariasse1
  23. PERFORM consortium (Personalised Risk assessment in febrile children to optimise Real-life Management across the European Union)
  1. 1Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
  2. 2Department of Paediatric Infectious Diseases and Immunology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
  3. 3Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Munchen, Germany
  4. 4German Centre for Infection Research, Braunschweig, Germany
  5. 5Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
  6. 6Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  7. 7Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle upon Tyne, UK
  8. 8Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  9. 9NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle University, Newcastle upon Tyne, UK
  10. 10Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Nijmegen, The Netherlands
  11. 11Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
  12. 12Section of Paediatric Infectious Diseases, Imperial College London, London, UK
  13. 13Department of General Paediatrics, Medical University of Graz, Graz, Austria
  14. 14Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  15. 15Department of Paediatric Emergency Medicine, Imperial College London, London, UK
  16. 16Genetics, Vaccines, Infections and Paediatrics Research Group, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  17. 17Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
  18. 18Department of Paediatrics, Children Clinical University Hospital, Riga, Latvia
  19. 19Department of Paediatrics, P. and A. Kyriakou Children's Hospital, Athens, Greece
  1. Correspondence to Joany M Zachariasse; j.zachariasse{at}erasmusmc.nl

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.

  • epidemiology
  • paediatric emergency medicine
  • infectious disease medicine
  • paediatrics

Data availability statement

Data are available on reasonable request. Data of this study are available on request from the corresponding author (j.zachariasse@erasmusmc.nl), subject to local rules and regulations.

https://doi.org/10.1136/archdischild-2024-327493

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    Data availability statement

    Data are available on reasonable request. Data of this study are available on request from the corresponding author (j.zachariasse@erasmusmc.nl), subject to local rules and regulations.

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    Footnotes

    • X @CarrolEnitan, @BennoKohlmaier, @ejlim8, @rgnijman

    • Contributors All authors contributed to the conception and design of the study and the interpretation of the findings. NK performed the analyses and wrote the first draft of the manuscript. CV, CDT and HAM provided insights on data analysis and oversaw the writing of the paper. UvB, EC, ME, MvdF, JAH, BK, ML, EL, IM, FM-T, RGN, MP, IR-C, AR, MT, DZ and WZ provided clinical contributions and insight on data collection. All authors commented on previous versions of the manuscript, and read and approved the final manuscript. JMZ accepts full responsibility for the finished work and the conduct of the study, had access to the data and controlled the decision to publish as the guarantor.

    • Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 848196. The research was supported by the National Institute for Health Research Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University.

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. For the remaining authors, no sources of funding were declared.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.