scholarly journals Predictors of pandemic influenza infection in adults presenting to two urban emergency departments, Toronto, 2009

CJEM ◽  
2011 ◽  
Vol 13 (01) ◽  
pp. 7-12 ◽  
Author(s):  
Todd C. Lee ◽  
Linda R. Taggart ◽  
Barbara Mater ◽  
Kevin Katz ◽  
Allison McGeer
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Pandemic Influenza ◽  
Emergency Departments ◽  
Clinical Decision Making ◽  
Influenza Infection ◽  
Clinical Decision ◽  
H1n1 Influenza ◽  
Influenza Activity ◽  
Wbc Count

ABSTRACT Objective: Identifying features that differentiate patients with H1N1 influenza infection from those with other conditions may assist clinical decision making during waves of pandemic influenza activity. Methods: From April 27 to June 15, 2009, nasopharyngeal swabs were obtained from all adults presenting to two urban emergency departments (EDs) with illness including fever or respiratory symptoms. H1N1 infection was detected by reverse transcriptase–polymerase chain reaction. Chart review was performed to compare cases of H1N1 influenza (n = 117) to matched controls. Results: The median age of cases was 35 years versus 50 years for controls (p < .001). In those with pre-existing conditions, asthma was present in 31% of cases versus 14% of controls (OR 2.6, 95% CI 1.3–5.4). Cough (OR 7.8, 95% CI 3.2–19), fever (OR 3.0, 95% CI 1.7–5.4), headache (OR 2.0, 95% CI 1.2–3.2), and myalgias (OR 1.9, 95% CI 1.2–3.1) were significantly more common in H1N1 cases. The median white blood cell count was 5.7 × 109/mL versus 10.9 × 109/mL (p < .001). The combination of fever and cough had an OR of 5.3. Fever, cough, low white blood cell (WBC) count, and tachycardia had the highest OR at 11. The absence of both fever and cough had a negative predictive value of 99%, but this occurred in only 8% of controls. Conclusion: In patients presenting to the ED, the combination of fever, cough, tachycardia, and WBC count < 10 × 109/mL was suggestive of H1N1 influenza infection. However, clinical features could not reliably distinguish influenza from other acute respiratory illnesses in adult ED patients.

scholarly journals A Vignette-Based Survey to Assess Clinical Decision Making Regarding Antibiotic Use and Hospitalization of Patients with Probable Aseptic Meningitis

2012 ◽  
Vol 23 (3) ◽  
pp. 125-129
Author(s):  
Glenn Patriquin ◽  
Jill Hatchette ◽  
Kevin Forward
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Baseline Scenario ◽  
Blood Cell Count ◽  
Laboratory Findings

BACKGROUND: The many etiologies of meningitis influence disease severity – most viral causes are self-limiting, while bacterial etiologies require antibiotics and hospitalization. Aided by laboratory findings, the physician judges whether to admit and empirically treat the patient (presuming a bacterial cause), or to treat supportively as if it were viral.OBJECTIVE: To determine factors that lead infectious disease specialists to admit and treat in cases of suspected meningitis.METHODS: A clinical vignette describing a typical case of viral meningitis in the emergency department was presented to clinicians. They were asked to indicate on a Likert scale the likelihood of administering empirical antibiotics and admitting the patient from the vignette and for eight subsequent scenarios (with varied case features). The process was repeated in the context of an inpatient following initial observation and/or treatment.RESULTS: Participants were unlikely to admit or to administer antibiotics in the baseline scenario, but a low Glasgow Coma Score or a high cerebrospinal fluid (CSF) white blood cell count with a high neutrophil percentage led to empirical treatment and admission. These factors were less influential after a negative bacterial CSF culture. These same clinical variables led to maintaining treatment and hospitalization of the inpatient.CONCLUSIONS: Most participants chose not to admit or treat the patient in the baseline vignette. Confusion and CSF white blood cell count (and neutrophil predominance) were the main influences in determining treatment and hospitalization. A large range of response scores was likely due to differing regional practices or to different levels of experience.

Association Between White Blood Cell Counts and Brachial-Ankle Pulse Wave Velocity in Chinese Hypertensive Adults: A Cross-Sectional Study

Angiology ◽  
2021 ◽  
pp. 000331972110211
Author(s):  
Buyun Jia ◽  
Chongfei Jiang ◽  
Yun Song ◽  
Chenfangyuan Duan ◽  
Lishun Liu ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Blood Cell ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
White Blood Cell ◽  
Pulse Wave ◽  
Final Analysis ◽  
Cross Sectional ◽  
Cell Counts ◽  
Wbc Count

Increased arterial stiffness is highly prevalent in patients with hypertension and is associated with cardiovascular (CV) risk. Increased white blood cell (WBC) counts may also be an independent risk factor for arterial stiffness and CV events. The aim of the study was to investigate the relationship between differential WBC counts and brachial-ankle pulse wave velocity (baPWV) in hypertensive adults. A total of 14 390 participants were included in the final analysis. A multivariate linear regression model was applied for the correlation analysis of WBC count and baPWV. Higher WBC counts were associated with a greater baPWV: adjusted β = 10 (95% CI, 8-13, P < .001). The same significant association was also found when WBC count was assessed as categories or quartiles. In addition, the effect of differential WBC subtypes, including neutrophil count and lymphocyte count on baPWV, showed the similar results. These findings showed that baPWV has positive associations with differential WBC counts in hypertensive adults.

scholarly journals Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Ademola Olusegun Talabi ◽  
Tewogbade Adeoye Adedeji ◽  
Oludayo Adedapo Sowande ◽  
Olusanya Adejuyigbe
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

scholarly journals Decrease in white blood cell counts after thiopentone barbiturate therapy for refractory intracranial hypertension: A common complication

2013 ◽  
Vol 04 (S 01) ◽  
pp. S31-S34 ◽  
Author(s):  
Shin Yi Ng ◽  
Ki Jinn Chin ◽  
Tong Kiat Kwek
Keyword(s):  
Statistical Analysis ◽  
Blood Cell ◽  
Intracranial Hypertension ◽  
White Blood Cell ◽  
Retrospective Review ◽  
T Test ◽  
Barbiturate Coma ◽  
Barbiturate Therapy ◽  
The Mean ◽  
Wbc Count

ABSTRACT Background: Leucopenia has been reported after induction of thiopentone barbiturate therapy for refractory intracranial hypertension. However, the incidence and characterisitics are not well described. Aims: We performed a retrospective review to describe the incidence and characteristics of leucopenia after induction of thiopentone barbiturate therapy. Setting and Design: Our centre is a national referral centre for neurotrauma and surgery in a tertiary medical institution.Materials and Methods: We performed a retrospective review of all patients who received thiopentone barbiturate therapy for refractory intracranial hypertension during an 18 month period from January 2004 to June 2005 in our neurosurgical intensive care unit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 15.0. All data are reported as mean ± standard deviation or median (interquartile range). The Chi square test was used to analyze categorical data and student t test done for comparison of means. For paired data, the paired t?test was used.-test was used. Results: Thirty eight (80.9%) out of 47 patients developed a decrease in white blood cell (WBC) count after induction of thiopentone barbiturate coma. The mean decrease in WBC from baseline to the nadir was 6.4 × 10 9 /L (P <lt; 0.001) and occurred 57 (3-147) h after induction. The mean nadir WBC was 8.6 < 3.6 × 10 9 /L. Three (6.4%) patients were leucopenic, with a WBC count of 2.8, 3.1, and 3.6 < 10 9 /L. None of them were neutropenic. We did not find an association between decrease in WBC count and clinical diagnosis of infection. We did not find any association between possible risk factors such as admission GCS, maximum ICP prior to induction of barbiturate coma, APACHE II score, total duration and dose of thiopentone given, and decrease in WBC count. Conclusions: Decrease in WBC count is common, while development of leucopenia is rare after thiopentone barbiturate coma. Regular monitoring of WBC counts is recommended.

A Silk Purse from a Sow's Ear?

PEDIATRICS ◽  
1981 ◽  
Vol 68 (2) ◽  
pp. 305-306
Author(s):  
James K. Todd
Keyword(s):  
Blood Cell ◽  
Study Design ◽  
White Blood Cell ◽  
Viral Illness ◽  
Prior Literature ◽  
Object Lesson ◽  
Wbc Count

In the 1970s it became axiomatic that a manuscript discussing the value of the white blood cell (WBC) count and differential would be an object lesson in flawed study design and inaccurate interpretation of prior literature. Somehow I always seem to get dragged into the argument with the mistaken impression that I feel, as misquoted by Dr Karniski, that a "CBC could accurately distinguish between any child with bacteremia and a child with a viral illness."

scholarly journals Cutoff Value for Correcting White Blood Cell Count for Nucleated Red Blood Cells: What is it? Why is it Important?

2019 ◽  
Vol 50 (4) ◽  
pp. e82-e90 ◽  
Author(s):  
Benie T Constantino ◽  
Gilbert Keith Q Rivera
Keyword(s):  
Blood Cell ◽  
Red Blood Cells ◽  
White Blood Cell ◽  
Blood Cells ◽  
Leukocyte Count ◽  
Nucleated Red Blood Cells ◽  
Cutoff Values ◽  
Long Time ◽  
Wbc Count ◽  
Manual Correction

Abstract Nucleated red blood cells (RBCs) are normally observed in the peripheral blood of neonates and during pregnancy. Under other conditions, the presence of nucleated RBCs in circulating blood indicates disorder in the blood-producing mechanism. The increased presence of nucleated RBCs, however, falsely elevates the leukocyte count, as measured by most automated hematology analyzers, warranting a manual correction of the leukocyte count. For a long time, cutoff values for correcting white blood cell (WBC) count for the presence of nucleated RBCs have been used regularly, particularly in developing countries. However, because those values are largely subjective, they can vary widely between laboratories worldwide. These varied cutoff values include 1, 5, 10, 20, and 50; it appears that the numbers 5 and 10 are the most common values used in corrections; the reasons require further elucidation. In this article, we discuss the merits of correcting the WBC count for nucleated RBCs at certain cutoff points.

Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial

2020 ◽  
Author(s):  
Masafumi Ono ◽  
Mariusz Tomaniak ◽  
Wolfgang Koenig ◽  
Ramzi Khamis ◽  
Ranil de Silva ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Blood Cell ◽  
White Blood Cell ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Open Label ◽  
Experimental Strategy ◽  
Percutaneous Coronary ◽  
Wbc Count ◽  
Reference Strategy

Abstract Aims The aim of this study was to investigate the efficacy and safety of ticagrelor monotherapy in patients undergoing percutaneous coronary intervention (PCI) stratified according to the baseline white blood cell (WBC) count. Methods and results This is a post hoc analysis of the GLOBAL LEADERS trial, a multi-centre, open-label, randomized all-comer trial in patients undergoing PCI, comparing the experimental strategy (23-month ticagrelor monotherapy following 1-month dual anti-platelet therapy [DAPT]) with the reference strategy (12-month aspirin monotherapy following 12-month DAPT). Patients were stratified into two WBC groups, either &lt; or ≥median WBC count of 7.8 × 109 cells/L (lower or higher WBC group, respectively). The primary endpoint was a composite of all-cause mortality or new Q-wave myocardial infarction at 2 years. Of 14 576 patients included in the present study, 7212 patients (49.5%) were classified as the lower WBC group, who had a significantly lower risk of both ischaemic and bleeding outcomes at 2 years. At 2 years, the experimental strategy was associated with a significant lower incidence of the primary endpoint compared with the reference strategy in the lower WBC group [2.8% vs. 4.2%; hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.52–0.86] but not in the higher WBC group (4.8% vs. 4.7%; HR: 1.01; 95% CI: 0.82–1.25; Pinteraction=0.013). There were no significant differences in the risks of Bleeding Academic Research Consortium type 3 or 5 bleeding between two anti-platelet strategies regardless of the WBC groups. Conclusion Increased WBC counts, which may reflect degree of inflammation, at the time of index procedure may attenuate the anti-ischaemic benefits of ticagrelor monotherapy observed in patients with lower WBC counts.

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