# Elevated band count in the pediatric patient

## TL;DR

This paper reviews the use of elevated band count in pediatric emergency care, highlighting its limitations and variable reliability as a diagnostic tool.

## Contribution

The paper systematically reviews the literature to question the clinical utility of elevated band count in pediatric patients.

## Key findings

- Elevated band count does not reliably correlate with severe illness or bacterial infection in pediatric patients.
- Manual band count measurements show wide variability, raising concerns about their clinical usefulness.
- Current AAP guidelines do not recommend using band count for decision-making in febrile neonates.

## Abstract

In this review article we survey the literature for current evidence in pediatric practice regarding the use of elevated band count in the pediatric emergency room. In addition, we present data from the literature on the wide variability of manual band counts to reconsider its utility in clinical practice.

Bandemia is commonly seen during a state of infection. Band count is determined by manual cell count and can be prone to inaccuracy and imprecision. Despite its shortcomings, the 100-cell manual differential count remains the most practical method for assessing left shift.

All the literature involving the use of elevated band count as a biomarker in pediatrics available on PubMed and Google Scholar was surveyed. “Bandemia”, “Band count”, “left shift” and “immature neutrophils” were used as primary search terms, in conjunction with the term “pediatrics.”

The most recent AAP guidelines do not incorporate band count in decision making for febrile neonates. Elevated band count is related to worse outcomes in non-operative management of appendicitis. Elevated band count can be seen in viral illness alone. Even severe bandemia (<20%) does not correlate with severe illness.

More studies are needed to definitively dispel the notion of bandemia and its association with invasive bacterial infection. Additionally, pediatric providers may benefit from professional society guidelines advising appropriate management of the pediatric patient with elevated band count.