Journal article
The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study
- Abstract:
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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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Accepted manuscript, pdf, 428.6KB, Terms of use)
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- Publisher copy:
- 10.1136/archdischild-2024-327493
Authors
Contributors
- Institution:
- University of Oxford
- Division:
- MSD
- Department:
- Paediatrics
- Role:
- Contributor
- ORCID:
- 0000-0001-7361-719X
- Funder identifier:
- https://ror.org/00k4n6c32
- Grant:
- 848196
- Programme:
- Horizon 2020
- Funder identifier:
- https://ror.org/029chgv08
- Grant:
- 104439/Z/14/Z
- Publisher:
- BMJ Publishing Group
- Journal:
- Archives of Disease in Childhood More from this journal
- Volume:
- 110
- Issue:
- 3
- Pages:
- 191-196
- Place of publication:
- England
- Publication date:
- 2025-02-27
- Acceptance date:
- 2024-09-11
- DOI:
- EISSN:
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1468-2044
- ISSN:
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0003-9888
- Pmid:
-
39332842
- Language:
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English
- Keywords:
- Pubs id:
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2357595
- UUID:
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uuid_8660cde3-2cb2-4662-8358-b5ebb97a43b0
- Local pid:
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pubs:2357595
- Source identifiers:
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W4402917767
- Deposit date:
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2026-02-09
- ARK identifier:
Terms of use
- Copyright holder:
- Kemps et al
- Copyright date:
- 2025
- Rights statement:
- © Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.
- Notes:
- This is the accepted manuscript version of the article. The final version is available online from BMJ Publishing Group at https://dx.doi.org/10.1136/archdischild-2024-327493
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