Daniel J Isaacman1, Bonnie L Burke. 1. Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, 601 Children's Lane, Norfolk, VA 23507, USA. disaacma@chkd.com
Abstract
OBJECTIVE: To assess the utility of serum C-reactive protein (CRP) as a screen for occult bacterial infection in children. METHODS: Febrile children ages 3 to 36 months who visited an urban children's hospital emergency department and received a complete blood cell count and blood culture as part of their evaluation were prospectively enrolled from February 2, 2000, through May 30, 2001. Informed consent was obtained for the withdrawal of an additional 1-mL aliquot of blood for use in CRP evaluation. Logistic regression and receiver operator characteristic (ROC) curves were modeled for each predictor to identify optimal test values, and were compared using likelihood ratio tests. RESULTS: Two hundred fifty-six patients were included in the analysis, with a median age of 15.3 months (range, 3.1-35.2 months) and median temperature at triage 40.0 degrees C (range, 39.0 degrees C-41.3 degrees C). Twenty-nine (11.3%) cases of occult bacterial infection (OBI) were identified, including 17 cases of pneumonia, 9 cases of urinary tract infection, and 3 cases of bacteremia. The median white blood cell count in this data set was 12.9 x 10(3)/ micro L [corrected] (range, 3.6-39.1 x10(3)/ micro L) [corrected], the median absolute neutrophil count (ANC) was 7.12 x 10(3)/L [corrected] (range, 0.56-28.16 x10(3)/L) [corrected], and the median CRP level was 1.7 mg/dL (range, 0.2-43.3 mg/dL). The optimal cut-off point for CRP in this data set (4.4 mg/dL) achieved a sensitivity of 63% and a specificity of 81% for detection of OBI in this population. Comparing models using cut-off values from individual laboratory predictors (ANC, white blood cell count, and CRP) that maximized sensitivity and specificity revealed that a model using an ANC of 10.6 x10(3)/L [corrected] (sensitivity, 69%; specificity, 79%) was the best predictive model. Adding CRP to the model insignificantly increased sensitivity to 79%, while significantly decreasing specificity to 50%. Active monitoring of emergency department blood cultures drawn during the study period from children between 3 and 36 months of age showed an overall bacteremia rate of 1.1% during this period. CONCLUSIONS: An ANC cut-off point of 10.6 x10(3)/L [corrected] offers the best predictive model for detection of occult bacterial infection using a single test. The addition of CRP to ANC adds little diagnostic utility. Furthermore, the lowered incidence of occult bacteremia in our population supports a decrease in the use of diagnostic screening in this population.
OBJECTIVE: To assess the utility of serum C-reactive protein (CRP) as a screen for occult bacterial infection in children. METHODS: Febrile children ages 3 to 36 months who visited an urban children's hospital emergency department and received a complete blood cell count and blood culture as part of their evaluation were prospectively enrolled from February 2, 2000, through May 30, 2001. Informed consent was obtained for the withdrawal of an additional 1-mL aliquot of blood for use in CRP evaluation. Logistic regression and receiver operator characteristic (ROC) curves were modeled for each predictor to identify optimal test values, and were compared using likelihood ratio tests. RESULTS: Two hundred fifty-six patients were included in the analysis, with a median age of 15.3 months (range, 3.1-35.2 months) and median temperature at triage 40.0 degrees C (range, 39.0 degrees C-41.3 degrees C). Twenty-nine (11.3%) cases of occult bacterial infection (OBI) were identified, including 17 cases of pneumonia, 9 cases of urinary tract infection, and 3 cases of bacteremia. The median white blood cell count in this data set was 12.9 x 10(3)/ micro L [corrected] (range, 3.6-39.1 x10(3)/ micro L) [corrected], the median absolute neutrophil count (ANC) was 7.12 x 10(3)/L [corrected] (range, 0.56-28.16 x10(3)/L) [corrected], and the median CRP level was 1.7 mg/dL (range, 0.2-43.3 mg/dL). The optimal cut-off point for CRP in this data set (4.4 mg/dL) achieved a sensitivity of 63% and a specificity of 81% for detection of OBI in this population. Comparing models using cut-off values from individual laboratory predictors (ANC, white blood cell count, and CRP) that maximized sensitivity and specificity revealed that a model using an ANC of 10.6 x10(3)/L [corrected] (sensitivity, 69%; specificity, 79%) was the best predictive model. Adding CRP to the model insignificantly increased sensitivity to 79%, while significantly decreasing specificity to 50%. Active monitoring of emergency department blood cultures drawn during the study period from children between 3 and 36 months of age showed an overall bacteremia rate of 1.1% during this period. CONCLUSIONS: An ANC cut-off point of 10.6 x10(3)/L [corrected] offers the best predictive model for detection of occult bacterial infection using a single test. The addition of CRP to ANC adds little diagnostic utility. Furthermore, the lowered incidence of occult bacteremia in our population supports a decrease in the use of diagnostic screening in this population.
Authors: Xiaoyang Yu; Bodil Larsen; Jennifer Rutledge; Lori West; David B Ross; Ivan M Rebeyka; Holger Buchholz; Jia Li Journal: Interact Cardiovasc Thorac Surg Date: 2012-05-22
Authors: Karim M Mansour; Frans A Kuypers; Tammy N Wang; Annabeth M Miller; Sandra K Larkin; Claudia R Morris Journal: Am J Emerg Med Date: 2010-08-13 Impact factor: 2.469
Authors: Peter Paul C Lim; Dayle J Bondarev; Amy M Edwards; Claudia M Hoyen; Charles G Macias Journal: Pediatr Res Date: 2022-08-04 Impact factor: 3.953
Authors: Gijs Elshout; Miriam Monteny; Johannes C van der Wouden; Bart W Koes; Marjolein Y Berger Journal: BMC Fam Pract Date: 2011-05-16 Impact factor: 2.497