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

BMC Pediatr. 2022 Nov 4;22(1):633. doi: 10.1186/s12887-022-03677-5.

Authors

Liselore De Rop¹, Tine De Burghgraeve², An De Sutter³, Frank Buntinx^{2

4}, Jan Y Verbakel^{2

5}

Affiliations

¹ EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium. liselore.derop@kuleuven.be.
² EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
³ Department of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
⁴ Research Institute Caphri, Maastricht University, Maastricht, The Netherlands.
⁵ NIHR Community Medtech and IVD cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

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: Acute illness; C-reactive protein; Child; Point-of-care systems; Primary care; Serious infections.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

C-Reactive Protein
Anti-Bacterial Agents

Associated data

ClinicalTrials.gov/NCT02024282