Outcomes of Bandemia Without Leukocytosis in the ED

Outcomes of Bandemia Without Leukocytosis in the ED

Alisa Dewald et al.
American Journal of Emergency Medicine, August 7, 2025

🩺 Clinical Implications

• Bandemia alone is not benign—even in the absence of leukocytosis, it is associated with measurable rates of sepsis and poor outcomes.
  
  

• A normal WBC does not exclude serious infection—do not ignore bandemia.
  
  

• Early risk stratification in ED patients with bandemia—even without leukocytosis—may improve detection of evolving sepsis.
  
  

• Future research may assess utility of automated band counts in ED workflows.

📌 Study Overview

• Design: Retrospective observational study using the TriNetX Global Network (143 institutions across 22 countries)
  
  

• Population: Adults (18–90 y/o) presenting to the ED with:
  
  

• Bandemia: >10% immature neutrophils (ICD-10 D72.825)
  
  

• Normal WBC count: <10,000 cells/mm³
  
  

• Timeframe: December 2004 – December 2024
  
  

• Primary outcomes: Within 7 days—sepsis, severe sepsis, bacteremia, and mortality
  
  

📊 Key Results

• Total patients: 13,785
  
  

• Within 7 days of ED visit:
  
  

• Sepsis: 4.4%
  
  

• Severe sepsis: 2.4%
  
  

• Bacteremia: 1.5%
  
  

• Mortality: 0.58%
  
  

• Common presenting symptom: Abdominal/pelvic pain (10.7%)
  
  

• Hospital admission or observation: 5.1%
  
  

Dewald, A., Caggiula, A., Camp, S., Tran, Q.K., Zinabu, S., Shapovalov, V., Groussis, M., Alabdulaly, N. and Pourmand, A., 2025. Outcomes of Bandemia without leukocytosis in the emergency department: A retrospective analysis. The American Journal of Emergency Medicine.