Outcomes of Bandemia without leukocytosis in the emergency department: A retrospective analysis

Authors

Alisa Dewald, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Amy Caggiula, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Samantha Camp, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: samantha.camp@som.umaryland.edu.
Q K. Tran, Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA, United States. Electronic address: qtran@som.umaryland.edu.
Samrawit W. Zinabu, Department of Internal Medicine, Howard University Hospital, Washington, DC, United States.
Vadym Shapovalov, Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, PA, United States.
Maria Groussis, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Nasser Alabdulaly, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Ali Pourmand, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.

Document Type

Journal Article

Publication Date

8-7-2025

Journal

The American journal of emergency medicine

Volume

98

DOI

10.1016/j.ajem.2025.08.006

Keywords

Bandemia; Emergency department; Leukocytosis; Sepsis

Abstract

BACKGROUND: Bandemia, defined as >10 % immature neutrophil precursor cells, is a recognized marker of infection. While its clinical significance has been demonstrated the context of leukocytosis, the prognostic value of bandemia with normal level of white blood cell count (WBC) is underexplored. This study aimed to evaluate clinical outcomes associated with bandemia in the absence of leukocytosis among emergency department (ED) patients. METHODS: We conducted a retrospective observational study using de-identified data from the TriNetX Global Collaborative Network, encompassing 143 healthcare organizations across 22 countries. Adult patients (aged 18-90) presenting to the ED with bandemia (ICD-10-CM D72.825) and a normal WBC count (<10 × 10 cells/mm) between December 2004 and December 2024 were included. Primary outcomes assessed within one week of presentation included sepsis, severe sepsis, bacteremia, and mortality. RESULTS: A total of 13,785 patients met inclusion criteria. Within seven days of ED presentation, 4.4 % developed sepsis, 2.4 % progressed to severe sepsis, 1.5 % developed bacteremia, and 0.58 % died. The most common presenting symptom was abdominal or pelvic pain (10.7 %). Hospital inpatient or observational care was required in 5.1 % of cases. CONCLUSION: Bandemia in the absence of leukocytosis is associated with adverse infectious outcomes, particularly sepsis. These findings support the clinical utility of bandemia as an early indicator of infection, even in the setting of a normal WBC count. Incorporating bandemia into diagnostic evaluations may improve detection and outcomes in patients with early sepsis. Prospective studies are needed to validate these findings and assess the utility of automated band count technologies.

APA Citation

Dewald, Alisa; Caggiula, Amy; Camp, Samantha; Tran, Q K.; Zinabu, Samrawit W.; Shapovalov, Vadym; Groussis, Maria; Alabdulaly, Nasser; and Pourmand, Ali, "Outcomes of Bandemia without leukocytosis in the emergency department: A retrospective analysis" (2025). GW Authored Works. Paper 7802.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7802

Department

School of Medicine and Health Sciences Student Works