The clinical utility of the leukocyte differential in emergency medicine

Leukocyte differentials from 468 emergency room patients were assessed for clinical value by determining their associations with diagnosis, disposition, therapy, and prognosis. The test efficiency of an elevated band count as an indicator of infectious or inflammatory disease is 86%. However, all but 2 of the 99 patients in this disease category had additional indicators of inflammation, including elevated temperatures and/or white blood cell (WBC) counts. The band count lacks utility beyond this limited function. The remaining parameters of the differential count correlate poorly with all diagnostic subsets. The use of antibiotics correlates well with fever and WBC count (r = 0.95) and less well with the differential count, bands (r = 0.85), and granulocytes (r = 0.5). Elevations in the total WBC count and the band count are each associated with an increased likelihood of hospitalization. However, in the absence of leukocytosis, an elevated band count was instrumental in suggesting admission for only one patient. The patient's outcome correlates poorly with the total WBC and differential count. It is concluded that most leukocyte differentials performed for emergency room patients provide information that is no more clinically significant than that obtained from the medical history, physical examination, and absolute leukocyte count.