OBJECTIVES: To determine the clinical impact of positive results from blood cultures sent from a busy paediatric accident and emergency department. METHODS: All children who attended the department over a seven month period and had blood culture investigations were identified. Case notes of patients who had any growth on blood culture were reviewed to determine whether the organism was felt to be pathogenic and how the result affected clinical management. RESULTS: 1159 children had blood cultures sent, 26 of these grew an organism that was felt to be pathogenic. However, only five significantly influenced clinical management. CONCLUSIONS: Blood cultures sent from an accident and emergency department rarely influence clinical management. A more focused approach to bacteriological investigation is recommended.