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BMC Pediatrics
Published in: BMC Pediatrics 1/2022

Open Access 01-12-2022 | Antibiotic | Research

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

Authors: Liselore De Rop, Tine De Burghgraeve, An De Sutter, Frank Buntinx, Jan Y Verbakel

Published in: BMC Pediatrics | Issue 1/2022

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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).
Appendix
Available only for authorised users
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Metadata
Title
Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study
Authors
Liselore De Rop
Tine De Burghgraeve
An De Sutter
Frank Buntinx
Jan Y Verbakel
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2022
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-022-03677-5

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