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Children with Fever and Acute Lower Extremity Pain: Is a Blood Culture Warranted?

April 7, 2023

How often do you encounter a child with fever and acute extremity pain and order a blood culture as part of the workup? While bacteremia can certainly be associated with a bone or joint infection, is bacteremia so common that a blood culture should be a routine part of the evaluation?

Helou et al from Boston Children’s Hospital and the American University of Beirut Medical Center (10.1542/peds.2022-059504) share with us a cross-sectional analysis of children  (ages 1-18 years) who presented to an emergency department (ED) over a decade with fever and acute lower extremity pain. The authors used natural language processing (NLP) to sort through 478,000+ ED notes and found 689 patients who had fever and acute lower extremity pain, of whom 510 had blood cultures drawn. 

The authors found that 70 of the 510 blood cultures (13.7%) were positive, a percentage that is likely higher than may have been expected. These results confirm the importance of blood cultures for children who present with acute onset of fever and extremity pain. Other factors associated with a positive blood culture include localized examination findings and an elevated C-reactive protein.

Make no bones about it—this study makes you think strongly about drawing a blood culture on every child with acute onset of fever and leg pain—but if you want to be convinced—link to the study and learn more.

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