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Logo of bmcpediBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Pediatrics
 
BMC Pediatr. 2012; 12: 140.
Published online Sep 3, 2012. doi:  10.1186/1471-2431-12-140
PMCID: PMC3457842
Impact of C-reactive protein test results on evidence-based decision-making in cases of bacterial infection
Mona Nabulsi,corresponding author1 Abeer Hani,1 and Maria Karam1
1Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, P.O. Box: 113-6044/C8, Beirut, Lebanon
corresponding authorCorresponding author.
Mona Nabulsi: mn04/at/aub.edu.lb; Abeer Hani: abeer.hani/at/duke.edu; Maria Karam: mk126/at/aub.edu.lb
Received February 27, 2012; Accepted August 3, 2012.
Abstract
Background
C-reactive protein (CRP) is widely used to detect bacterial infection in children. We investigated the impact of CRP test results on decision-making and summarized the evidence base (EB) of CRP testing.
Methods
We collected information from the hospital records of 91 neonates with suspected sepsis and of 152 febrile children with suspected infection on the number of ordered CRP tests, the number of EB-CRP tests, and the impact of the test results on decision-making. CRP diagnostic accuracy studies focusing on pediatric infections were reviewed critically. The main outcomes were the proportion of CRP tests that were EB and the proportion of tests that affected decision-making. A secondary outcome was the overall one-year expenditure on CRP testing.
Results
The current EB for CRP testing in pediatric infections is weak and suggests that CRP is of low diagnostic value. Approximately 54.8% of tests performed for suspected neonatal sepsis and 28% of tests performed for other infections were EB; however, the results of only 12.9% of neonatal sepsis tests and of 29.9% of tests on children with other infections informed decision-making. The one-year overall cost for CRP testing and related health care was $26,715.9.
Conclusions
The routine ordering of CRP for children with infections is based on weak evidence. The impact of the CRP test results on decision-making is rather small, and CRP ordering may contribute to unnecessary health care expenditures. Better quality research is needed to definitively determine the diagnostic accuracy of CRP levels in children with infections.
Keywords: C-reactive protein, Neonatal sepsis, Bacterial infection, Diagnostic accuracy
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