Overall, we screened 2250 hospital records (nursery
1485; pediatric ward
765). Of these, 243/2250 (10.8%) hospital admissions met our inclusion criteria: 91/243 (37.4%) from the NICU and 152/243 (62.6%) from the pediatric ward. These cases constituted 6.1% (91/1485) of nursery admissions and 19.9% (152/765) of overall ward admissions, respectively. A total of 517 CRP tests were performed during one year: 254/517 (49.1%) for the ward patients and 263/517 (50.9%) for the NICU patients. The baseline characteristics of the NICU and ward patients and their values of the CRP-related variables are detailed in Tables and , respectively.
Baseline characteristics of NICU and ward patients
NICU and ward patients’ CRP-related outcomes and costs
For the 91 NICU admissions, 263 CRP tests were performed during the initial work up of suspected neonatal sepsis episodes. Of these, 144/263 (54.8%) were serial CRP tests and hence were considered evidence based (EB), whereas the remaining 119/263 (45.2%) tests were single tests and were considered non-evidence based (non-EB). The mean (SD) number of CRP tests performed per neonate was 2.9 (2.7), with a range of 1-12 tests. Among all of these CRP tests, only 34/263 (12.9%) had an impact on clinical decision-making in terms of continuing or stopping antibiotics. In the remaining cases, treatment decisions were based on culture results and/or the baby’s clinical picture, irrespective of the value of CRP.
For the 152 children admitted to the pediatric ward, the admission diagnoses were pneumonia (40), acute gastroenteritis (28), bacteremia (25), urinary tract infection (13), acute otitis media (10), meningitis (7), soft tissue/bone/joint infections (4), acute sinusitis (4), appendicitis (3), tonsillitis (2), and other miscellaneous infections (16). There was an evidence base for ordering CRP in the ED for 40/152 (26.3%) cases. The mean (SD) number of CRP tests performed per child during the hospital stay was 1.7 (1.0), with a range of 1-6 tests. Of the 254 CRP tests performed during the hospital stays of these patients, 178 (70.1%) failed to inform decision-making and/or resulted in further unnecessary additional health care.
Regarding the cost, the overall charges for the 517 CRP tests performed during one year was $25,316.3. In the NICU, the overall CRP charges were $12,799.3, with a mean (SD) of $140.7 (131.7) per neonate. Approximately $5986 (46.8%) of the total CRP charges in the NICU was spent on tests that were unsupported by evidence. When the impact of CRP testing on decision-making was taken into consideration, the overall cost of the 229/263 (87.1%) CRP tests that failed to inform decision-making was estimated at $11,148.2.
Regarding ward admissions, the overall CRP charges were $12,517 with a mean (SD) of $82.3 (48.4) per patient. Tests that were unsupported by evidence were estimated to cost $8868.7 (70.9% of total ward CRP charges). Non-EB testing resulted in the further ordering of laboratory or radiologic tests, additional antibiotic treatment, or the prolongation of the hospital stay for some cases, thus leading to additional charges amounting to $6793.3. When the impact of CRP testing on clinical decision-making was considered by including the CRP tests that failed to inform decision-making and/or resulted in further unnecessary additional health care, the expenditure on CRP testing increased to $15,567.7. As a result, our one-year charges for routine CRP testing in the NICU and for non-EB testing for other pediatric infections amounted to $26,715.9.