Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study

Liselore De Rop; Tine De Burghgraeve; An De Sutter; Frank Buntinx; Jan Y Verbakel

doi:10.1186/s12887-022-03677-5

Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study

Liselore De Rop^*, Tine De Burghgraeve, An De Sutter, Frank Buntinx, Jan Y Verbakel

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Acute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients' characteristics, care setting, preliminary diagnosis, and management.

METHODS: A prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium.

RESULTS: In this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was 10 mg/L (IQR < 5-29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13-113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10-58) compared to 7 mg/L (IQR < 5-19) when they were not prescribed.

CONCLUSION: A low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02024282 (registered on 31/12/2013).

Original language	English
Article number	633
Number of pages	9
Journal	Bmc Pediatrics
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12887-022-03677-5
Publication status	Published - 4 Nov 2022

Keywords

Child
Adult
Humans
Infant
Child, Preschool
C-Reactive Protein/analysis
Point-of-Care Systems
Infections/diagnosis
Anti-Bacterial Agents/therapeutic use
Pneumonia/drug therapy
Primary Health Care

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10.1186/s12887-022-03677-5Licence: CC BY

Cite this

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title = "Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study",

abstract = "BACKGROUND: Acute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients' characteristics, care setting, preliminary diagnosis, and management.METHODS: A prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium.RESULTS: In this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was 10 mg/L (IQR < 5-29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13-113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10-58) compared to 7 mg/L (IQR < 5-19) when they were not prescribed.CONCLUSION: A low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02024282 (registered on 31/12/2013).",

keywords = "Child, Adult, Humans, Infant, Child, Preschool, C-Reactive Protein/analysis, Point-of-Care Systems, Infections/diagnosis, Anti-Bacterial Agents/therapeutic use, Pneumonia/drug therapy, Primary Health Care",

author = "{De Rop}, Liselore and {De Burghgraeve}, Tine and {De Sutter}, An and Frank Buntinx and Verbakel, {Jan Y}",

note = "{\textcopyright} 2022. The Author(s).",

year = "2022",

month = nov,

day = "4",

doi = "10.1186/s12887-022-03677-5",

language = "English",

volume = "22",

journal = "Bmc Pediatrics",

issn = "1471-2431",

publisher = "BioMed Central Ltd",

number = "1",

}

TY - JOUR

T1 - Point-of-care C-reactive protein test results in acute infections in children in primary care

T2 - an observational study

AU - De Rop, Liselore

AU - De Burghgraeve, Tine

AU - De Sutter, An

AU - Buntinx, Frank

AU - Verbakel, Jan Y

PY - 2022/11/4

Y1 - 2022/11/4

N2 - BACKGROUND: Acute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients' characteristics, care setting, preliminary diagnosis, and management.METHODS: A prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium.RESULTS: In this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was 10 mg/L (IQR < 5-29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13-113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10-58) compared to 7 mg/L (IQR < 5-19) when they were not prescribed.CONCLUSION: A low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02024282 (registered on 31/12/2013).

AB - BACKGROUND: Acute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients' characteristics, care setting, preliminary diagnosis, and management.METHODS: A prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium.RESULTS: In this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was 10 mg/L (IQR < 5-29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13-113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10-58) compared to 7 mg/L (IQR < 5-19) when they were not prescribed.CONCLUSION: A low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02024282 (registered on 31/12/2013).

KW - Child

KW - Adult

KW - Humans

KW - Infant

KW - Child, Preschool

KW - C-Reactive Protein/analysis

KW - Point-of-Care Systems

KW - Infections/diagnosis

KW - Anti-Bacterial Agents/therapeutic use

KW - Pneumonia/drug therapy

KW - Primary Health Care

U2 - 10.1186/s12887-022-03677-5

DO - 10.1186/s12887-022-03677-5

M3 - Article

C2 - 36333682

SN - 1471-2431

VL - 22

JO - Bmc Pediatrics

JF - Bmc Pediatrics

IS - 1

M1 - 633

ER -