This study aims to quantify the ability of abnormal temperature, white blood cell (WBC) count, and bandemia to identify bacteremia in ED patients with suspected infection.
This was a post hoc analysis of data collected for a prospective, observational, cohort study. Consecutive adult (age 鈮?18 years) patients who presented to the ED of a tertiary care center between February 1, 2000 and February 1, 2001 and had blood cultures obtained in the ED or within 3 h of admission were enrolled. Patients with bacteremia were identified and charts were reviewed for presence of normal temperature (36.1-38掳C/97-100.4掳F), normal WBC (4-12 K/渭L), and presence of bandemia (> 5%of WBC differential).
There were 3563 patients enrolled; 289 patients (8.1%) had positive blood cultures. Among patients with positive blood cultures, 33%had a normal body temperature and 52%had a normal WBC count. Bandemia was present in 80%of culture-positive patients with a normal temperature and 79%of culture-positive patients with a normal WBC count. Fifty-two (17.4%) patients with positive blood cultures had neither an abnormal temperature nor an abnormal WBC.
A significant percentage of ED patients with blood culture-proven bacteremia have a normal temperature and WBC count upon presentation. Bandemia may be a useful clue for identifying occult bacteremia.