Does leucocytosis identify bacterial infections in febrile neonates presenting to the emergency department?
Does leucocytosis identify bacterial infections in febrile neonates presenting to the emergency department?
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白细胞增多是否可以识别到急诊科就诊的发热新生儿的细菌感染？
DOI：
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发表时间：
2005
影响因子：
3.1
通讯作者：
W. Wittlake
中科院分区：
文献类型：
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作者：
L. Brown;T. Shaw;W. Wittlake
目的：本研究旨在评价外周白色血细胞（WBC）计数在急诊室就诊的发热新生儿（> 28天）队列中识别细菌感染的鉴别能力。方法：采用描述性统计和受试者工作特征（ROC）曲线对病历进行回顾性分析。纳入了1999年1月1日至2002年8月22日期间在三级护理儿科急诊科就诊、体温> 38°C、接受腰椎穿刺并获得WBC计数的新生儿。根据微生物学和放射学检查结果将他们分为四组：细菌感染、病毒感染、肺炎和阴性败血症评估。结果：共69例发热新生儿符合纳入标准。每组中的新生儿数量如下：8例细菌感染，10例病毒感染，3例肺炎，48例脓毒症评价阴性。各组间WBC计数存在大量重叠。ROC曲线下面积为0.7231（95%CI 0.5665 - 0.8797）。结论：在急诊室评价的发热新生儿队列中，WBC计数在识别新生儿细菌感染方面具有适度的区分能力，并显示出组间的大量重叠。目前的数据表明，在急诊科就诊的发热新生儿中，不应使用任何WBC计数阈值来识别细菌感染。
Objective: This study was undertaken to evaluate the discriminatory power of the peripheral white blood cell (WBC) count to identify bacterial infections in a cohort of febrile neonates (⩽28 days of age) presenting to an emergency department. Methods: Retrospective medical record review using descriptive statistics and a receiver operating characteristic (ROC) curve. Neonates who presented to a tertiary care paediatric emergency department between 1 January 1999 and 22 August 2002, had a temperature ⩾38°C, underwent lumbar puncture, and had a WBC count obtained were included. They were divided according to microbiological and radiographic findings into four groups: bacterial infections, viral infections, pneumonia, and negative sepsis evaluations. Results: A total of 69 febrile neonates met the inclusion criteria. The number of neonates in each group was as follows: 8 with bacterial infections, 10 with viral infections, 3 with pneumonias, and 48 with negative sepsis evaluations. There was substantial overlap in WBC counts among the groups. The area under the ROC curve was 0.7231 (95% CI 0.5665 to 0.8797). Conclusion: In a cohort of febrile neonates evaluated in the emergency department, the WBC count had modest discriminatory power in identifying neonates with bacterial infections and demonstrated substantial overlap among groups. The present data suggest against the use of any WBC count threshold to identify bacterial infections in febrile neonates presenting to the emergency department.