Objective: Fever without source (FWS) is a common cause of children visits to pediatric practices. Clinical evaluation does not always rule out efficiently an invasive bacterial infection. Among blood markers, several publications have suggested the value of C-reactive protein (CRP). This study was performed to assess, in private practices, the impact of rapid CRP test compared to usual technique at the laboratory for the management of children with FWO.
Material and methods: The study was undertaken in 2006-2007, in 14 pediatric practices. Pediatricians had to enroll all children, older than three months, consulting for FWS, for whom CRP was prescribed. The pediatric practices were distributed in two groups: in the first one, pediatricians had rapid CRP tests (NycoCard) CRP test, Progen Biotechnique) and in the second one, they sent children to laboratory for the dosage of CRP as usually.
Results: Between October 2006 and June 2007, 227 children were enrolled by 17 pediatricians: 159 in the group with rapid CRP test (group 1), 68 in the group without (group 2). The cost of routine biological tests (micro or macro CRP, blood cell count and urine cultures) was on average lower for group 1 compared to the group 2: respectively 7.7 versus 39.3 euro (P<0.0001), a reduction from approximately 80% of cost. In group 1, more dipstick urine tests (22.6 versus 4.4, P=0.0009), less urine cultures (19.5% versus 67.6% P<0.0001) and blood prescriptions were prescribed (3.8% versus 100%, P<0.0001), pulmonary X-rays were not different (23.9% versus 19.1%, P=0.4). It was not observed difference in antibiotic prescription between the two groups (15.7% group 1 versus 19.1% group 2, p=0.5). The average time to obtain the results examinations in laboratory was approximately 11h (median 4.5h, extremes 45 min to two days), for five min in group 1. In group 1, children management was different according to the CRP levels. During the follow-up, no difference was observed between the two groups except less hospitalizations in group 1 (2.9% versus 15.3%, P=0.0015).
Conclusion: This study suggests the interest of rapid CRP test for febrile children in ambulatory pediatric practice by reducing number and cost of laboratory examinations and timesaving for patients and practitioners.