Najafali Daniel, Kaur Noorvir, Afridi Ikram, Abdalla Norhan, Afridi Leenah, Sahadzic Iana, Solomon Julianna, Yardi Isha, Tran Quincy K
Research Associate Program in Emergency Medicine and Critical Care, University of Maryland School of Medicine, Baltimore, USA.
Cureus. 2021 Feb 12;13(2):e13303. doi: 10.7759/cureus.13303.
The presence of band cells > 10% of the total white blood cell (WBC) count ("bandemia") is often used as an indicator of serious bacterial illness (SBI). Results from studies of bandemia as a predictor of SBI were conflicting and little is known about the relationship between severe bandemia (SB) and clinical outcomes from SBI in children. We hypothesized that SB (band level > 20%) is not associated with adverse outcomes in an emergency department (ED) pediatric population.
Medical records from children between the ages of two months and 18 years with SB who presented to a tertiary referral regional hospital were studied. Outcomes were categorized as severe adverse events (SAEs) or moderate adverse events (MAEs). Multivariate logistic regressions were used to assess the association between SB and outcomes.
We analyzed 102 patients. Mean age (standard deviation, SD) was 5.25 (0.5) years, 18 (18%) had MAE, 21 (21%) had SAE, and no patients died. Mean band levels were similar between groups: no adverse events 28 (10) vs. SAE 31 (9) vs. MAE 27 (8), p=0.64. Multivariate logistic regressions showed SB was not associated with any adverse events (odds ratio (OR) 1.04, 95% confidence interval (CI) 0.9-1.1, p=0.27). Non-normal X-ray (XR) (OR 17, 95% CI 3.3-90, p<0.001) was associated with MAE, while non-normal computerized tomography (CT) scan (OR 15.4, 95% CI 2.2-100+, p=0.002) was associated with SAE.
SB was not associated with higher odds of adverse events among the general ED pediatric population. Clinicians should base their clinical judgment on the overall context of history, physical examinations, and other laboratory and imaging data.
杆状核细胞占白细胞（WBC）总数的比例>10%（“杆状核细胞增多”）常被用作严重细菌感染（SBI）的指标。关于杆状核细胞增多作为SBI预测指标的研究结果相互矛盾，对于儿童严重杆状核细胞增多（SB）与SBI临床结局之间的关系知之甚少。我们假设SB（杆状核细胞水平>20%）与急诊科（ED）儿科患者的不良结局无关。
对一家三级转诊区域医院收治的2个月至18岁患有SB的儿童的病历进行研究。结局分为严重不良事件（SAEs）或中度不良事件（MAEs）。采用多因素逻辑回归分析评估SB与结局之间的关联。
我们分析了102例患者。平均年龄（标准差，SD）为5.25（0.5）岁，18例（18%）发生MAE，21例（21%）发生SAE，无患者死亡。各组的平均杆状核细胞水平相似：无不良事件组为28（10），SAE组为31（9），MAE组为27（8），p = 0.64。多因素逻辑回归分析显示，SB与任何不良事件均无关联（比值比（OR）为1.04，95%置信区间（CI）为0.9 - 1.1，p = 0.27）。异常的X线（XR）检查（OR为17，95%CI为3.3 - 90，p < 0.001）与MAE相关，而异常的计算机断层扫描（CT）（OR为15.4，95%CI为2.2 - 100+，p = 0.002）与SAE相关。
在普通ED儿科患者中，SB与不良事件的较高发生率无关。临床医生应根据病史、体格检查以及其他实验室和影像学数据的整体情况进行临床判断。
