Febrile seizures with leukocytosis as a predictor for occult bacteremia
First published: 12 April 2019
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ped.13862
Abstract
Background
Febrile children 3‐36 months old, who had a body temperature > 39 °C and white blood cell count > 15,000/mm3 were known to be at risk for occult pneumococcal bacteremia (OPB) in the pre‐pneumococcal conjugate vaccine (PCV) era. However, the positive predictive value of this criteria decreased dramatically after introduction of PCV, which indicates a need for alternative criteria. Previous studies demonstrated a high rate of febrile seizures in children with OPB, suggesting that screening may still be practical in this population. We performed a retrospective analysis to evaluate factors that predict OPB in patients visiting the Emergency department (ED) with febrile seizures.
Methods
Children with 3‐36 months old who visited the ED for febrile seizures and had blood cultures taken were included. Patients with underlying diseases were excluded from the analysis. We performed statistical analyses comparing patient demographics according to the presence or absence of OPB.
Results
One thousand and eighty‐two patients visited the ED with febrile seizures and blood cultures were taken in 397, of which 87% had received more than three doses of PCV. Among the nine cases that had OPB, eight (89%) met risk criteria. In contrast, only 12% (48/388) of those without OPB met criteria. In this population, those who fulfilled risk criteria were more likely to have OPB than those who did not (14.3% vs. 0.3%; likelihood ratio 7.17).
Conclusions
High white blood cell count and fever may effectively predict OPB in pediatric patients who have febrile seizures in the post‐PCV era.
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