21 - Prevalence of Bacteremia Among Children Evaluated for Fever and Acute Lower Extremity Pain in the Emergency Department– A Validation Study

Poster Number: 21
Publication Number: 21.11

James Rudloff, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Rachelle El Helou, American University of Beirut Medical Center, Dbayeh, Mont-Liban, Lebanon; Fahd A. Ahmad, Washington University in St. Louis, St. Louis, MO, United States; Assaf Landschaft, Boston Children's Hospital, Bergisch Gladbach, Nordrhein-Westfalen, Germany; Marvin B. Harper, Harvard Medical School, North Reading, MA, United States; Amir Kimia, Boston Children's Hospital, Boston, MA, United States

Background: A recent study showed a high rate of bacteremia among pediatric patients presenting with fever and acute lower extremity pain, suggesting that blood cultures should be obtained routinely in these patients. The original study results, conducted in a Lyme-endemic region, may have underestimated the prevalence of bacteremia.

Objective: To assess the prevalence of bacteremia among children presenting with fever and acute lower extremity pain at a single-center pediatric emergency department.

Design/Methods: Cross-sectional chart review of all children aged 1-18 years presenting to the ED with fever and acute lower extremity pain between 2020-2022. We identified our cohort using a Natural Language Processing (NLP)-assisted model with manual review and abstracted clinical data. We excluded patients with trauma within the previous 24 hours, orthopedic comorbidity, immunocompromised status, sickle cell disease, or antibiotic pretreatment. Our primary outcome was bacteremia with a pathogen.

Results: We manually screened 1,343 notes from 79,346 available ED notes to achieve 95% sensitivity using our validated NLP model. We identified 51 patients who met inclusion criteria. Median age was 6 years [IQR 1.5,10], 29.4% were female. 41/51 (80.3%) patients had blood culture drawn.

Blood cultures were positive in 10/41 (24.4%, 95% CI 12.9-20.6%) of children. Of patients seen initially in our ED (excluding transfers), the prevalence was 3/29 (10.3%, 95% CI 2.7-28.5%) The identified pathogens were Methicillin-susceptible Staphylococcus aureus in 8/10 patients (80 %) and Methicillin-resistant Staphylococcus aureus in 2/10 patients (20 %). Patients with bacteremia had significantly elevated CRP and ESR and were more likely to be older (Table 1).  

Of the 10 patients with bacteremia, 7 had osteomyelitis, 2 had septic arthritis, and 1 had pyomyositis.

Conclusion(s): The prevalence of bacteremia among children presenting to the ED with fever and acute lower extremity pain is high. Our data supports the recommendation to obtain routine blood culture in the initial evaluation of children presenting with fever and acute lower extremity pain regardless of Lyme-endemic status.