Background
Methods
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sepsis (including bacteraemia): pathogenic bacteria isolated from blood culture
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meningitis: pleocytosis or identification of bacteria or a virus in cerebrospinal fluid
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appendicitis: histology
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pneumonia: infiltrate on chest X-ray
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osteomyelitis: pathogens from bone aspirate or a MRI or bone scan suggestive for osteomyelitis
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cellulitis: acute suppurative inflammation of the subcutaneous tissues
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bacterial gastroenteritis: pathogen isolated from stool culture
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complicated urinary tract infection: > 105/mL pathogens of a single species isolated from urine culture and systemic effects such as fever
Results
CRP in all children (n = 1730) | CRP only in children at clinical risk (n = 1417) |
P value | |||
---|---|---|---|---|---|
n
| % or IQR |
n
| % or IQR | ||
Male | 942 | 53.4 % | 735 | 51.9 % | 0.36 |
Age (median) | 3.6 | 1.6–8 | 2.7 | 1.3–5.5 | < 0.0001 |
Fever ≥ 38 °C | 961 | 85.7 % | 949 | 87.6 % | 0.19 |
Duration of fever | 2 | 1–2 | 2 | 1–2 | 0.99 |
Diarrhoea or vomiting | 409 | 24.2 % | 347 | 25.0 % | 0.61 |
Breathlessness | 99 | 6.0 % | 65 | 4.7 % | 0.13 |
Body temperature ≥ 40 °C | 119 | 7.6 % | 120 | 9.5 % | 0.09 |
Diarrhoea and 12–30 Months | 75 | 4.4 % | 77 | 5.6 % | 0.15 |
Clinician concern | 192 | 11.6 % | 148 | 10.8 % | 0.48 |
Impact of testing strategy on clinical management
CRP in all children (n = 1730) | CRP only in children at clinical risk (n = 1417) | Odds ratio adjusted for age and clustering | ||||
---|---|---|---|---|---|---|
n
| % |
n
| % | AOR | (95 % CI) | |
CRP tested | 1730 | 100 % | 285 | 20.1 % | – | |
Referred to hospital | 50 | 2.9 % | 30 | 2.1 % | 0.61 | (0.31–1.21) |
Serious infection | 7 | 0.40 % | 4 | 0.28 % | 0.61 | (0.15–2.39) |
Not CRP tested | 0 | 0 | 0 | 0 | – | |
Referred immediately | 2 | 0.16 % | 2 | 0.14 % | 1.16 | (0.16–8.41) |
Delayed admission | 5 | 0.29 % | 2 | 0.14 % | 0.43 | (0.07–2.53) |
Diagnostic performance of CRP
CRP in all children | CRP only in children at clinical risk | |||||
---|---|---|---|---|---|---|
Missed cases | n/N | % | 95 % CI | n/N | % | 95 % CI |
≥ 5 mg/L | 0/7 | 0 | 0.0–40.9 | 0/4 | 0 | 0.0–60.2 |
≥ 20 mg/L | 3/7 | 42.9 | 9.9–81.6 | 3/4 | 75 | 19.4–99.4 |
≥ 80 mg/L | 6/7 | 85.7 | 42.1–99.6 | 4/4 | 100 | 39.7–100 |
≥ 200 mg/L | 6/7 | 85.7 | 42.1–99.6 | 4/4 | 100 | 39.7–100 |
False alarms | n/N | % | 95 % CI | n/N | % | 95 % CI |
≥ 5 mg/L | 918/1723 | 53.3 | 49.9–56.8 | 161/281 | 57.3 | 51.3–63.2 |
≥ 20 mg/L | 448/1723 | 26.0 | 23.9–28.1 | 85/281 | 30.2 | 24.9–36.0 |
≥ 80 mg/L | 65/1723 | 3.8 | 2.9–4.8 | 14/281 | 5.0 | 2.8–8.2 |
≥ 200 mg/L | 2/1723 | 0.1 | 0.0–0.4 | 2/281 | 0.7 | 0.0–2.5 |
Children referred to hospital with normal CRP
# | Reason for referral to hospital | Additional tests ordered by GP | Highest temperature (°C) | Clinician concern (GP) | Admitted to hospital | Final discharge diagnosis |
---|---|---|---|---|---|---|
1 | Rule out pneumonia | Chest X-ray; urine culture | 40.2 | Yes | No | Viral URTI |
2 | Rule out meningitis | Urine culture | 38.2 | Yes | No | Viral URTI |
3 | Rule out meningitis | Urine culture | 39.7 | Yes | No | Viral URTI |
4 | Rule out ketoacidosis | Glycaemia fingerstick | 35.9 | Yes | Yes | Viral URTI |
5 | Rule out pneumonia | Urine culture | 40.5 | Yes | No | Viral URTI |
6 | Rule out UTI | None | 40 | Yes | No | Viral URTI |
7 | Might need intensive aerosol treatment | Urine culture | 39.6 | Yes | No | Viral URTI |
8 | Rule out pneumonia | FBC; chest X-ray | 38.5 | Yes | No | Viral URTI |
9 | Recurring otitis media | Urine culture | 37.5 | Yes | No | Viral URTI |
10 | Rule out pneumonia | Urine culture | 38 | Yes | No | Viral URTI |
11 | Not resolving 3 days after start antibiotics | Urine culture | 38.8 | Yes | No | Viral URTI |
12 | Rule out pneumonia | FBC; ultrasound | – | No | No | Viral URTI |
13 | Recurring otitis media | none | 36.8 | No | No | Viral URTI |
14 | Rule out UTI | Urine culture | 38.4 | Yes | No | UTI |
15 | Rule out UTI | Urine culture | 40.5 | Yes | No | UTI |
16 | Rule out UTI | Urine culture | 36.1 | No | No | UTI |
17 | Rule out UTI | Urine culture | 36.6 | Yes | No | Viral gastroenteritis |
18 | Grunting | Chest X-ray; ultrasound | 37.1 | Yes | No | Viral gastroenteritis |
19 | Rule out bacterial gastroenteritis | Stool culture | – | Yes | Yes | Viral gastroenteritis |
20 | Rule out appendicitis | None | 37.6 | Yes | No | Viral gastroenteritis |
21 | Rule out appendicitis | None | 35.6 | No | No | Viral gastroenteritis |
22 | Rule out appendicitis | Ultrasound; stool culture | – | No | No | Viral gastroenteritis |
23 | Rule out parasites | FBC; urine culture | 37.0 | No | No | Viral gastroenteritis |
24 | Rule out appendicitis | Ultrasound | 36.4 | No | No | Viral gastroenteritis |