1578 The Correlation Between C-Reactive Protein and Serious Bacterial Infection in a Tertiary Paediatric Emergency Department: An Observational Case-Controlled Cohort Study

A 3-month-old baby is brought to the paediatric emergency department by their parents because of a fever. You decide to check their inflammatory markers. Their C-reactive protein (CRP) level comes back as 20 mg/L. Does this affect whether or not you start antibiotic therapy? Does it influence your decision to admit or discharge the patient? CRP is a commonly used biochemical test and yet its use is constantly debated and challenged. We look at the current evidence and suggest the best way to use this test in clinical practice.

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Comparison of peripheral and central capillary refill time in febrile children presenting to a paediatric emergency department and its utility in identifying children with serious bacterial infection

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308519 ◽

2016 ◽

Vol 102 (1) ◽

pp. 17-21 ◽

Cited By ~ 2

Author(s):

Evelien de Vos-Kerkhof ◽

Tarik Krecinic ◽

Yvonne Vergouwe ◽

Henriëtte A Moll ◽

Ruud G Nijman ◽

...

Keyword(s):

Emergency Department ◽

Body Temperature ◽

General Population ◽

Bacterial Infection ◽

Capillary Refill Time ◽

Radiographic Findings ◽

Capillary Refill ◽

Clinical Criteria ◽

Paediatric Emergency Department ◽

Paediatric Emergency

ObjectiveTo determine the agreement between peripheral and central capillary refill time (pCRT/cCRT) and their diagnostic values for detecting serious bacterial infection (SBI) in febrile children attending the paediatric emergency department (ED).DesignProspective observational study.SettingPaediatric ED, Erasmus Medium Care-Sophia Children's hospital, the Netherlands.Patients1193 consecutively included, previously healthy, febrile children (1 month–16 years) with both pCRT measurements and cCRT measurements available. SBI diagnosis was based on abnormal radiographic findings and/or positive cultures from normally sterile locations in addition to clinical criteria.Main outcome measuresAgreement between pCRT and cCRT (Cohen's κ), overall and stratified for age and body temperature. The diagnostic value of pCRT and cCRT for SBI was assessed with logistic regression.ResultsOverall agreement was 0.35 (95% CI 0.27 to 0.43; considered ‘fair’). Although not significant, agreement was lower in children aged 1–<5 years (κ: 0.15 (95% CI 0.04 to 0.27)) and decreased with higher body temperatures with κ ranging from 0.55 (95% CI 0.32 to 0.79) for temperature <37.5°C to 0.21 (95% CI 0.07 to 0.34) for temperature >39.5°C. Abnormal pCRT (>2 s) was observed in 153 (12.8%; 95% CI 10.9% to 14.7%) and abnormal cCRT in 55 (4.6%; 95% CI 3.4% to 5.8%) children. The OR of abnormal pCRT (>2 s) for predicting SBI was 1.10 (95% CI 0.65 to 1.84). For abnormal cCRT (>2 s), the OR was 0.43 (95% CI 0.13 to 1.39).ConclusionsThe pCRT and cCRT values showed only fair agreement in a general population of febrile children at the ED, and no significant association with age or body temperature was found. Only a small part of febrile children at risk for serious infections at the ED show abnormal CRT values. Both abnormal pCRT and cCRT (defined as >2 s) performed poorly and were non-significant in this study detecting SBI in a general population of febrile children.

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High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2016-015112 ◽

2017 ◽

Vol 7 (10) ◽

pp. e015112 ◽

Cited By ~ 7

Author(s):

Ryo Yoshinaga ◽

Yasufumi Doi ◽

Katsuhiko Ayukawa ◽

Shizukiyo Ishikawa

Keyword(s):

Cardiovascular Disease ◽

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

High Sensitivity ◽

Inhospital Mortality ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp

ObjectiveWe investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD).DesignA retrospective cohort study.SettingED of a teaching hospital in Japan.Participants12 211 patients with CVD aged ≥18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated.Main outcome measuresInhospital mortality.Results1156 patients had died. The inhospital mortality increased significantly with the hs-CRP levels (<3.0 mg/L: 7.0%, 95% CI 6.4 to 7.6; 3.1–5.4 mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5–11.5 mg/L: 11.2%, 95% CI 9.4 to 13.0; 11.6–33.2 mg/L: 12.3%, 95% CI 10.5 to 14.1 and ≥33.3 mg/L: 19.9%, 95% CI 17.6 to 22.2). The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ≥5.5 mg/L groups compared with the <3.0 mg/L group (5.5–11.5 mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005; 11.6–33.2 mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ≥33.3 mg/L: HR=2.15, 95% CI 1.84 to 2.51, p<0.001). Similar findings were observed for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage. This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing. When the causes of death were divided into primary CVD and non-CVD deaths, the association between initial hs-CRP levels and mortality remained significant, but the influence of hs-CRP levels was greater in non-CVD deaths than CVD deaths. The percentage of non-CVD deaths increased with hs-CRP levels; among the patients with hs-CRP levels ≥33.3 mg/L, non-CVD deaths accounted for 37.5% of total deaths.ConclusionOur findings suggest that increased hs-CRP is a significant risk factor for inhospital mortality among patients with CVD in an ED. Particular attention should be given to our finding that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.

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