Idan Segal1, Matityahu Ehrlichman2, Joseph Urbach1, Maskit Bar-Meir2. 1. Paediatric Department, Shaare-Zedek Medical Center, Jerusalem, Israel. 2. Paediatric Department, Shaare-Zedek Medical Center, Jerusalem, Israel Faculty of Medicine, Hebrew University, Jerusalem, Israel.
Abstract
OBJECTIVE: To determine whether the input of time from fever onset will change the accuracy of C-reactive protein (CRP) in diagnosing bacterial infections in febrile children. STUDY DESIGN: We performed a prospective observational study on febrile children presenting to the emergency department. The diagnostic performance of CRP at different time points from fever onset was compared using a receiver operating characteristic (ROC) curve. RESULTS: Among 373 patients included, 103 (28%) had bacterial infection. The optimal cut-off for CRP suggesting bacterial infection changed with time from fever onset: 6 mg/dL for >12-24 h of fever; 10.7 and 12.6 mg/dL at >24-48 and >48 h of fever, respectively. The input of time from fever onset improved the area under the ROC curve from 0.83 (95% CI 0.78 to 0.88) for CRP overall to 0.87 (95% CI 0.77 to 0.96) and 0.90 (95% CI 0.84 to 0.97) at >24-48 and >48 h of fever, respectively. Duration of fever mostly affected the ability of CRP to correctly rule out bacterial infections. CRP level of 2 mg/dL obtained at ≤24 h of fever corresponds with a post-test probability for bacterial infection of 10%, whereas the same value obtained >24 h of fever reduces the risk to 2%. CONCLUSIONS: Clinicians should apply different CRP cut-off values depending on whether they are trying to rule in or rule out bacterial infection, but also depending on fever duration at the time of CRP testing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: To determine whether the input of time from fever onset will change the accuracy of C-reactive protein (CRP) in diagnosing bacterial infections in febrile children. STUDY DESIGN: We performed a prospective observational study on febrile children presenting to the emergency department. The diagnostic performance of CRP at different time points from fever onset was compared using a receiver operating characteristic (ROC) curve. RESULTS: Among 373 patients included, 103 (28%) had bacterial infection. The optimal cut-off for CRP suggesting bacterial infection changed with time from fever onset: 6 mg/dL for >12-24 h of fever; 10.7 and 12.6 mg/dL at >24-48 and >48 h of fever, respectively. The input of time from fever onset improved the area under the ROC curve from 0.83 (95% CI 0.78 to 0.88) for CRP overall to 0.87 (95% CI 0.77 to 0.96) and 0.90 (95% CI 0.84 to 0.97) at >24-48 and >48 h of fever, respectively. Duration of fever mostly affected the ability of CRP to correctly rule out bacterial infections. CRP level of 2 mg/dL obtained at ≤24 h of fever corresponds with a post-test probability for bacterial infection of 10%, whereas the same value obtained >24 h of fever reduces the risk to 2%. CONCLUSIONS: Clinicians should apply different CRP cut-off values depending on whether they are trying to rule in or rule out bacterial infection, but also depending on fever duration at the time of CRP testing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Nga T T Do; Ngan T D Ta; Ninh T H Tran; Hung M Than; Bich T N Vu; Long B Hoang; H Rogier van Doorn; Dung T V Vu; Jochen W L Cals; Arjun Chandna; Yoel Lubell; Behzad Nadjm; Guy Thwaites; Marcel Wolbers; Kinh V Nguyen; Heiman F L Wertheim Journal: Lancet Glob Health Date: 2016-08-03 Impact factor: 26.763
Authors: Jan Y Verbakel; Marieke B Lemiengre; Tine De Burghgraeve; An De Sutter; Bert Aertgeerts; Bethany Shinkins; Rafael Perera; David Mant; Ann Van den Bruel; Frank Buntinx Journal: BMC Med Date: 2016-10-06 Impact factor: 8.775