Fifty percent or more of children with upper respiratory infections (URIs) and nonspecific febrile illnesses (e.g., children febrile, anorexic, decreased activity, irritable) receive unnecessary antibiotics from community-based physicians. This study was undertaken to show that white blood cell (WBC) count testing can aid physicians in avoiding antibiotic prescribing when managing children with URIs, and nonspecific febrile illnesses. A prospective, 3-year study was conducted in a community-based pediatric practice. A weekly convenience sample (Tuesdays) of acute URI and febrile patients ages 3 months to 21 years was studied. Data collected on enrollment included: age, gender, duration of illness, recent/current antibiotic use, temperature, symptoms, signs, laboratory testing (WBC count, cultures), diagnosis and treatment. Similar data on any illness visits in the previous 2 weeks and the subsequent 2 weeks after enrollment were collected. Viral culture specimens were obtained on a subset. The use of the WBC count was assessed, including obviating antibiotic prescription, frequency of related follow-up visits, and the occurrence of subsequent bacterial infections. Of 1,956 patients with respiratory or febrile illness enrolled, 1,219 (62%) had a diagnosis established by history and examination (e.g., acute otitis media) and 737 (38%) did not. Of the 737 patients without an established diagnosis, 386 (52%) did not receive an antibiotic because they did not appear particularly ill, their temperature was less than 101 degrees F, and parents were not demanding antibiotics, leaving 351 (48%) patients who appeared ill, had a temperature greater than 101 degrees F, and parents were demanding an antibiotic or physicians were inclined to give an antibiotic. A WBC count was performed on these 351 children; 337 children (96%) had a WBC count less than 15,000/mm3, and 14 (4%) had a WBC 15,000/mm3 or greater. An antibiotic was prescribed for 13 of the 14 children with a WBC count greater than 15,000/mms. With this approach, return office visits in the following 2 weeks were infrequent (13% of 737 patients), and no child had significant bacterial illness that was missed. With selective use of WBC count testing
"We believed a more moderate leukocytosis would be more predictive of severe disease. This value has been used in other studies to assist in estimating severity of disease [14–15]. Variables thought to be clinically related to disposition decisions from the OU or found to be relevant in prior research were first evaluated by a fitted model for univariate analysis. "
[Show abstract][Hide abstract] ABSTRACT: Skin and soft tissue infections are a common admission diagnosis to emergency department (ED) observation units (OU). Little is known about which patients fail OU treatment.
This study evaluates clinical factors of skin or soft tissue infections associated with further inpatient treatment after OU treatment failure.
A structured retrospective cohort study of consecutive adults treated for abscess or cellulitis in our OU from April 2005 to February 2006 was performed. Records were identified using ICD-9 codes and were abstracted by two trained abstractors using a structured data collection form. Significant variables on univariate analysis P < 0.1 were entered into a multivariate logistic regression.
A total of 183 patient charts were reviewed. Four patients with a non-infectious diagnosis were excluded, leaving 179 patients. The median age was 41 (interquartile range: 20-74). Following observation treatment, 38% of patients required admission. The following variables were evaluated for association with failure to discharge home: intravenous drug use, gender, a positive community-acquired methicillin-resistant Staphylococcus aureus culture, age, presence of medical insurance, drainage of an abscess in the ED, diabetes and a white blood cell count (WBC) greater than 15,000. Following multivariate analysis only female gender odds ratio (OR) 2.33 [95% confidence interval (CI): 1.06-5.15] and WBC greater than 15,000 OR 4.06 (95% CI: 1.53-10.74) were significantly associated with failure to discharge.
Among OU patients treated for skin and soft tissue infections, women were twice as likely to require hospitalization and patients with a WBC > 15,000 on presentation to the ED, regardless of gender, were 4 times more likely to require hospitalization.
International Journal of Emergency Medicine 07/2008; 1(2):85-90. DOI:10.1007/s12245-008-0029-z
[Show abstract][Hide abstract] ABSTRACT: A low or normal white blood cell (WBC) count is usually associated with viral illnesses. This study evaluated the reliability of a new point-of-care, inexpensive, WBC count device which requires only 10 microL (1 drop) of whole blood from a finger stick to an automated Cell-Dyn counter in a busy office practice setting and assessed its reliability to assist in avoiding antibiotic prescribing. A total of 120 acutely ill children and potential antibiotic recipients were studied from October 2007 to March 2008. The mean WBC count was 7.4x10(9)/L and 8.1x10( 9)/L for the new WBC device and the automated Cell-Dyn counter, respectively. The correlation between the 2 devices was high (r=.988, P=.005). A total of 88 children (73%) did not receive antibiotics and mean WBC was 7.2x10(9)/L. In all, 32 children (27%) received an antibiotic and 1 (3%) returned for a follow-up office visit for the same or a related illness. Of the 88 children with a low blood count who did not receive an antibiotic, 3 (3%) had return visit within 30 days and received an antibiotic. A simple and quick point-of-care WBC count device produces similar results as achievable with a Cell-Dyn counter for total WBCs and may assist in judicious antibiotic prescribing.
[Show abstract][Hide abstract] ABSTRACT: White blood cell (WBC) count and C-reactive protein (CRP) level are the most common markers of inflammation. There is a growing need for point-of-care testing (POCT) of WBC and CRP, and more advances in convenient devices are required. We developed an analyzer-free POCT system for measuring WBC and CRP using a low volume blood sample.
The POCT-WBC is based on the granulocyte esterase assay, while the POCT-CRP is based on the immunochromatographic assay. These kits were examined for precision as well as correlation with currently used popular commercial automated assays. The correlations were clinically analyzed in children with acute infection (n = 62; mean age 4.2 y). The correlations regarding the monitoring of values were further examined in several follow-up subjects.
The POCT-WBC and POCT-CRP kits demonstrated good precision. POCT-WBC exhibited a significantly close correlation with those of the control assay (r = 0.94, p < 0.05). The results of POCT-CRP also exhibited a significantly close correlation with those of the control assay (r = 0.94, p < 0.05). In the follow-up study, the results of the respective kits were similar to those of the control assays.
The POCT-WBC and POCT-CRP are promising tools for assessing infection in clinical practice.
Clinica chimica acta; international journal of clinical chemistry 03/2014; 433. DOI:10.1016/j.cca.2014.03.004 · 2.82 Impact Factor
Note: This list is based on the publications in our database and might not be exhaustive.
Magnus G Snipsøyr, Maja Ludvigsen, Eskild Petersen, Henrik Wiggers, Bent Honoré
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