Characteristics and Outcomes of Clinically Undetected Bacteremia in Children Discharged from the Emergency Department: a Retrospective Cohort

Objectives: The goal was to describe patient characteristics, microbial etiology, management and outcomes of bacteremic well appearing and previously healthy children 3–36 months of age discharged from the Emergency department on their index visit.

Methods: This was a retrospective cohort study of children presenting to Schneider Children medical Center between June 2015, and June 2021. Children were included if they were aged 3 to 36 months and immunocompetent, had a blood culture drawn; and were discharged from the ED- later growing a true pathogen. We extracted all demographic clinical and laboratory data from the patient’s integrated electronic medical records for the index and follow up visits as well as subsequent admissions and ambulatory data.

Results: During the study period, 17,298 children aged 3-36 months had blood culture testing during ED evaluation and were discharged home. 72 patients (0.42%) had positive cultures for known pathogens. The cultures of an additional 256 patients (1.4%) grew known contaminants. The most common true isolates were S. pneumonia 26.9%. (n=19), K. Kingae 25%. (n=18) and Salmonella spp. 13.9% (n=10).

70 (98.7%) patients had a second ED visit. 61 patients (83.5%) were admitted with a median length of stay of 5.6 days . No patient was admitted from the ED to intensive care. There were no deaths.

Conclusion: The rate of undetected true bacteremia in our study population of healthy & vaccinated well appearing children was low and our data suggests that given effective follow up this patient group can initially be safely managed as outpatients.