448 - The Utility of Elevated Manual Band Count in Children at an Inner-City Pediatric Emergency Department

Publication Number: 448.6803

Sabrina Rosengarten, New York Presbyterian Queens, Flushing, NY, United States; Dylan H. Nguyen, NewYork Presbyterian Queens, Flushing, NY, United States; Michelle Qu Zhao, New York Presbyterian Queens, Flushing, NY, United States; Faria Rahman, New York Presbyterian Queens, Flushing, NY, United States; Haroon Karabay, New York-Presbyterian Queens, Flushing, NY, United States; Ameer Hassoun, New York Presbyterian Queens, Jackson Heights, NY, United States

Background: An elevated level of Immature Neutrophils (Band cell count) has traditionally been considered a sign of serious bacterial infections (SBI). While the data has been conflicting, a band count of 10% or more is considered by clinicians as a marker of Systemic Inflammatory Response Syndrome (SIRS) or sepsis in children. While these data are extrapolated from adults or critical care units, the utility of this marker in the pediatric emergency department remains unclear.

Objective: Describe the common diagnoses associated with elevated band counts in children and evaluate it's utility in detecting SBIs at the pediatric emergency department.

Design/Methods: A retrospective descriptive study of patients two months to 18 years of age, with elevated manual band count of 10% or more, evaluated at the pediatric emergency department. All patients were assessed at a single community-based, university-affiliated urban pediatric emergency department in New York between June 1, 2021, and August 31, 2023. We collected demographic data, laboratory tests, final diagnosis, antibiotic use, and final disposition. The data was processed using SAS studio to define frequencies and statistical significance. The institutional review board at our hospital approved this study.

Results: The study included 271 patients, of whom 42% were females. The mean age was 7.5 years (± 6.8); Hispanic and Asian Americans represented 82.6% of our population. Respiratory viral infections (Table 1) were the most common diagnoses for elevated bands (26.1%). Acute gastroenteritis came in second (21%) (Table 2). Pneumonia, urinary tract infection (UTI), and Appendicitis were also frequent (Table 3). Bacteremia and UTI rates were 2.2% and 7.8%, respectively. 63% of patients with bandemia received antibiotics. The band count was higher in patients who received antibiotics (mean: 19.8 ± 9.4) than those who did not (mean: 16.7 ± 6.2) (p = 0.01). Elevated band count had a sensitivity of 18.6% (95% CI: 12.6-26%) and specificity of 82.4% (95% CI: 80-84%) in detecting SBI ( Bacteremia and UTI). It had a positive predictive value of 10% (95% CI: 7.2-13.7%) and a negative predictive value of 90.6% (95% CI: 89.9-91.3%).

Conclusion(s): In our population, elevated manual band count can be seen in viral and bacterial infections. Respiratory and gastrointestinal infections were the most frequent infections identified. Sepsis was infrequent. Two-thirds of patients were treated with antibiotics. Isolated elevated band count has low utility in detecting SBI. Further research is required to evaluate the utility of this blood marker in the decision to use antibiotics.

Table 1: Respiratory PCR Panel Results
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Table 2: Gastrointestinal PCR Panel Results
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Table 3: Top five diagnoses identified with elevated band count in children.
B9B19D24-2ADE-4CE0-8726-20B2E5BBC672_4_5005_c.jpeg*Respiratory viral infections include viral respiratory failure, bronchiolitis, croup, and acute pharyngitis.