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Temperature greater than or equal to 40 C in children less than 24 months of age: a prospective study
Insights
In young children with high fever, elevated white blood cell (WBC) counts and erythrocyte sedimentation rates (ESR) significantly increase the risk of bacteremia and pneumonia. These markers are effective in screening for serious infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Febrile illnesses in young children often require prompt diagnosis to rule out serious infections like bacteremia and pneumonia.
- Accurate and timely diagnostic markers are crucial for effective management of pediatric febrile illnesses.
Purpose of the Study:
- To evaluate the diagnostic utility of white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) in identifying bacteremia and pneumonia in febrile children under 24 months.
- To compare the effectiveness of WBC count and ESR with other hematological markers in screening for serious infections.
Main Methods:
- Prospective study of 330 children under 24 months presenting with fever (≥40°C) to an emergency room.
- Collection of data on WBC count, ESR, blood cultures, and chest X-rays for all patients.
- Analysis of the association between WBC count/ESR and the presence of bacteremia or pneumonia.
Main Results:
- Elevated WBC count (≥15,000/cu mm) or ESR (≥30 mm/hr) was associated with a threefold increased risk of bacteremia and a twofold increased risk of pneumonia.
- These markers were present in a significant proportion of children with confirmed bacteremia, pneumonia, or complicated otitis media.
- WBC count and ESR demonstrated greater effectiveness in screening than polymorphonuclear leukocyte or band counts.
Conclusions:
- Elevated WBC count and ESR are valuable indicators for screening young children with high fever for bacteremia, pneumonia, and complicated otitis media.
- These hematological parameters aid in identifying children who require further investigation for serious infections.
- The findings support the use of WBC count and ESR as accessible and effective diagnostic tools in pediatric emergency settings.
Abstract:
In a prospective study, 330 consecutive children less than 24 months old coming to the emergency room of Yale-New Haven Hospital with a temperature greater than or equal to 40 C were evaluated. Nearly all patients had a white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) (Wintrobe), blood culture, and chest roentgenogram. Eighty-eight percent were evaluated 24 to 48 hours later. The mean WBC count and ESR were significantly elevated in children with positive blood cultures or pneumonia. The risk of bacteremia was increased threefold and the risk of pneumonia was increased twofold in children with a WBC count greater than or equal to 15,000/cu mm or an ESR greater than or equal to 30 mm/hr compared to children without leukocytosis or elevated ESR. Sixty-one percent of children with bacteremia or pneumonia. 63% of children in whom these diagnoses were not apparent on physical examination, and 86% of children with otitis media complicated by pneumonia or bacteremia had either a WBC count greater than or equal to 15,000/cu mm or an ESR greater than or equal to 30 mm/hr. A WBC count greater than or equal to 15,000/cu mm and an ESR greater than or equal to 30 mm/hr were more effective than a polymorphonuclear leukocyte count greater than or equal to 10,000/cu mm and/or a band count greater than or equal to 500/cu mm in screening young children with high fever for bacteremia, pneumonia, or complicated otitis media.