Point-of-Care C-Reactive Protein Test Results in Acute Infections in Children in Primary Care: A Post-Hoc Analysis

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

Background:

Acute infections are common in children in primary care. Differentiating serious infections from self-limiting ones is challenging. Diagnostic uncertainty can lead to unnecessary antibiotic prescribing, additional testing, or referral. Point-of-care (POC) C-reactive protein (CRP) testing guides antibiotic prescribing in adults, however in children its use remains unclear and limited.

Research questions:

Assessing POC CRP level in relation to the diagnosis of acute infections in children in ambulatory care and assessing whether it can help differentiate between serious and non-serious infection.

Method:

A post-hoc analysis in which descriptive analyses were performed in children with an acute infection presenting to ambulatory care, defined as general practice (GP), paediatric outpatient clinic and emergency department (ED).

Results:

In this study 8280 cases were analysed, 6552 had a POC CRP value available. The median patient age was 1.98 years (IQR 0.97 to 4.17), 36.9% of children presented to a GP, 32.9% to a paediatric out-patient clinic, and 30,2% to the ED. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as most frequent. The median CRP over all infectious episodes was 10 mg/L (IQR <5-29). Young children had a higher median CRP. A serious infection was diagnosed in 6.2% (n=513) of patients. Most common was pneumonia. Median CRP in serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13-113). Antibiotics were prescribed in 27.7% (n=2030) of episodes. When antibiotics were prescribed, median CRP level was 29 mg/L (IQR 10-58) compared to 7 mg/L (IQR <5-19) when they were not prescribed.

Conclusions:

In our study, a low POC CRP as such 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

Points for discussion:

Use of POC CRP in children in primary care: how can it be used in assessing serious infections and to tackle antibiotics use?

Practical implication: will GPs use POC CRP? What are the facilitators and barriers?

A recent study estimated 1.27 million deaths attributable to antimicrobial resistance in 2019. Which other ways seem useful to tackle AB use in ambulatory care?

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