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Outcomes of Children Discharged from the Emergency Department With a Pending Blood Culture
Jennifer Y Colgan1, Kenneth A Michelson1, Jacqueline Corboy1
1Department of Pediatrics, Division of Emergency Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine.
Insights
Children discharged from the emergency department (ED) with a pending blood culture had higher rates of critical illness and infection upon return. Improved guidelines are needed to identify children requiring blood cultures for better diagnosis.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Children discharged from the emergency department (ED) with pending blood cultures may face risks of undiagnosed infections.
- Evaluating outcomes for these children is crucial for refining diagnostic and treatment protocols.
Purpose of the Study:
- To assess the incidence of critical illness and significant infections in pediatric patients discharged from the ED with an pending blood culture.
- To compare outcomes between children who had blood cultures drawn and those who did not during their initial ED visit.
Main Methods:
- A cross-sectional study analyzed data from 416,357 pediatric ED discharges (ages 90 days to 18 years) between 2016 and 2024.
- Primary outcome: specific bacteremia on ED re-presentation within 3 days. Secondary outcomes: sepsis, ICU admission, and prolonged antibiotic use.
- Outcomes were compared based on whether a blood culture was collected during the index ED visit.
Main Results:
- Of 416,357 discharges, 229,269 (55.1%) had blood cultures collected.
- Children with a blood culture on initial visit had higher odds of bacteremia (OR 10.86), sepsis (OR 3.16), ICU admission (OR 2.82), and prolonged antibiotics (OR 4.77) on return.
- Absolute rates of these adverse outcomes were low, even in the blood culture group.
Conclusions:
- Pediatric patients discharged with pending blood cultures exhibited increased rates of significant bacteremia and concerning return visits.
- Despite higher relative odds, the absolute incidence of these severe outcomes remained low.
- Current guidelines may require refinement to better identify pediatric patients who would benefit from blood cultures in the ED.
Objective:
To evaluate rates of critical illness and significant infection among children discharged from the emergency department (ED) with a pending blood culture.
Methods:
We conducted a cross-sectional study of children 90 days to 18 years old discharged from one of 37 pediatric EDs between 2016 and 2024 with a complete blood count or C-reactive protein performed. Our primary outcome was a diagnosis of specific bacteremia on representation to the ED within 3 days. Secondary outcomes on 3-day return visit included: (1) sepsis, (2) intensive care unit admission, and (3) receipt of ≥3 days of systemic antibiotics. We evaluated for differences in outcomes based on the performance of a blood culture on the index visit.
Results:
We included 416,357 discharges (median encounter age 6.3 y, IQR: 2.1 to 12.7). Of these, 229,269 (55.1%) had a blood culture collected. Among encounters with a blood culture, 0.1% (n = 151; 95% CI: 0.1-0.1) had specific bacteremia on return visit. Encounters with a blood culture at the index visit had higher odds of specific bacteremia [odds ratio (OR) 10.86, 95% CI: 5.8-20.34], sepsis (OR: 3.16, 95% CI: 1.88-5.30), intensive care unit admission (OR: 2.82, 95% CI: 1.94-4.12), and ≥3 days of systemic antibiotics (OR: 4.77, 95% CI: 4.17-5.46).
Conclusions:
Children discharged with a pending blood culture have higher rates of significant bacteremia and other clinically important return visits than children discharged without a blood culture, though absolute rates of these outcomes were low. Improved guidelines are needed to better identify children who require blood cultures.
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