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Journal update monthly top five
  1. Kirsty Challen1,
  2. Anukiran Ravichandran2,
  3. Matthew Chun Bond Chiu1,
  4. Thomas Ludlow1,
  5. Michael Rosser1,
  6. Robert Hirst3
  1. 1 Emergency Department, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  2. 2 Emergency Department, Royal Bolton Hospital, Bolton, UK
  3. 3 Emergency Department, Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to Dr Kirsty Challen, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, Lancashire, UK; kirsty.challen{at}

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This month’s update is by the Lancashire Teaching Hospitals team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

The papers are ranked as

  • Worth a peek: interesting but not yet ready for prime time.

  • Head turner: new concepts.

  • Game changer: this paper could/should change practice.

Biomarkers and their association with bacterial illnesses in hypothermic infants by Holland et al.

Topic: sepsis in infants

Outcome rating: worth a peek

Serious bacterial infection (SBI) in young infants can present with fever or hypothermia, but differentiating which hypothermic infants will have SBI is challenging. This multicentre retrospective study conducted across four US academic paediatric EDs investigated whether biomarkers could identify SBI in hypothermic (<36.4°C) infants (<90 days).1

Hypothermic infants who had blood cultures and full blood count (FBC) performed in the ED were included (n=850). The primary outcome was SBI (urinary tract infection, bacteraemia, or meningitis with/without bacteraemia (n=55)). The levels of biomarkers in those with and without SBI were compared as continuous variables, and accuracy at identifying SBI was assessed using the area under the receiver operator curve (AUROC).

White blood cell (WBC) count, absolute neutrophil count (ANC) and platelets were all higher in those with SBI (p<0.01). WBC and ANC showed moderate ability to identify children with SBI (AUROC 0.70 and 0.77), but performance of platelets was poor (AUROC 0.6) at identifying SBI. ANC demonstrated the best performance with a cut-off of 4.5×109/L, providing a sensitivity of 0.69 (0.55 to 0.81) and a specificity of 0.77 (0.74 to 0.8). A secondary preplanned exploratory analysis comparing serum procalcitonin and neutrophil bands was limited by low numbers (n=15) …

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  • Twitter @sassyEMtrainee, @hirstposition

  • Contributors KC, AR, MCBC, TL and MR were responsible for the search process, selection of the top five papers and writing of the paper summaries. RH reviewed the summaries, provided feedback and made edits to the revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.