Severe bandemia is not associated with increased risk for adverse events in general pediatric emergency department patients

ABSTRACT Background 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. Objectives In this retrospective patient-centered study, we hypothesized that SB (band level >20%) is not associated with adverse outcomes in an emergency department (ED) pediatric population. Methods Medical records from children between the ages of 2 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. Results 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. Conclusion Severe bandemia 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.