A great blog post about the “utility” of CBC in febrile children

Sean Fox over at the always informative Pediatric EM Morsels just posted a great, brief review of the “usefulness” of CBC – especially WBC in febrile children. It is entitled “Poor Utility of WBC Count for the Evaluation of Fever.”

You should all go read it – here’s the link.

Pediatric EM Morsels / Poor Utility of WBC Count for the Evaluation of Fever


My main point about CBC and WBC is that it is most useful when you have a defined reason to get it and it is supported by your clinical assessment and a validated schema that utilizes other tests in concert. Don’t just get a CBC to see if a patient has an infection. Also, have a reassuring discussion ready to go for the family and patient that has had a previous CBC that was sent, got them worried, but the kid looks great.

You can follow Sean on Twitter @PedEMMorsels

50 Words – January 2018

This is a new feature on PEMBlog. I will be summarizing recent articles in 50 words (or less). I know that all of you are busy, so I wanted to give a quick synopsis of current literature, and offer you a chance to see what’s out there. I highly encourage you to look at the individual studies to see what conclusions you’ll draw on your own of course.

HSV study group of the PEMCRC and Cruz et al.

Pediatrics, 2018

This multi center retrospective cross-sectional study of infants <60 days old who had CSF studies sent. 112 of 26,533 had HSV identified with >80%  in weeks 1 to 4; median age 14 days. HSV was more common in 0-28 days vs 29-60 days (OR 3.9; 95% CI: 2.4-6.2).

Barrick et al.

Pediatric Emergency Care, 2018

A review of nearly 5,000 encounters for urolithiasis in children saw a 14% decrease in CT as the first imaging modality and subsequent imaging modality. Concordantly, ultrasound use increased by 15%.

Wendt et al.

Academic Emergency Medicine, 2018

Unprovoked seizures are more likely to see recurrent seizures than febrile seizures (which are approximately 33%). The risk is estimated at 29%, 37%, 43%, and 46% at 1, 2, 5, and 10 years, respectively.

Verbal et al.

Arch Dis Child, 2017

This prospective Belgian study incorporated CRP + assessment and vitals into an algorithm for febrile children. CRP >75mg/L had a 26.8% risk of serious infection requiring admission. Well appearing kids had lower CRPs. It’s not validated in a multi-center manner yet; don’t use CRP alone to determine sick vs not.

Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections

Gerber et al.

JAMA, 2017

A retrospective cohort study of 6 months – 12 years with acute respiratory tract infection prescribed an oral antibiotic showed that broad-spectrum treatment (augmenting, cefdinir vs amox) was not associated with a lower rate of treatment failure but was more likely to have adverse events.

Kwak et al.

Seizure, 2017

Interestingly, a meta analysis showed that iron deficiency anemia is significantly associated with febrile seizures (OR, 1.98; 95% CI, 1.26-3.13; P=0.003). You still don’t need to send ion levels/ferritin in the ED at this point though. Treatment doesn’t necessarily reduce the risk of recurrence.

2017 Year in Review

It is natural to reflect at the end of the year. I wanted to share this post as a way to thank all of my readers and contributors and to give a full accounting of how the site performed over the past year. Sharing this data will hopefully allow me to continue to improve the site and expand PEMBlog’s educational reach in the service of my ongoing efforts to teach as many providers as possible about the care of ill and injured children.

Summary Statistics


This is an increase of 24% over 2016 (97,861)!

Overall I have noticed a steady increase in the number of visitors per month since the site launched in the summer of 2012. The green highlight in July 2017 indicates that that was the month with the most visits ever.


I was overjoyed to learn that I have readers from dozens of countries. The “heat map” below lists the top views by country.

Top Viewed Posts

Title Views
Removing earrings embedded in the ear lobe 12,084
Briefs: My baby threw up blood! 11,069
Synconvulsions: Just how common are convulsions in syncope? 10,134
Reducing pain during incision and drainage of abscesses 5,539
Post tonsillectomy hemorrhage 4,056
Absorbable versus nonabsorbable sutures 3,146
Chest X-Ray Challenge! 2,929
Briefs: It’s a private matter… 2,575
You don’t need an X-Ray to diagnose constipation! 2,265
A review of oxygen delivery devices 2,253