Alkhmees, Mohammed (2020) 1 The clinical value of C-reactive protein test in children at different health care settings. thesis, Medicine.
Full text available on request.Abstract
Introduction: C-reactive protein (CRP) is an inflammatory biomarker that can be tested for diagnostic, prognostic and monitoring purposes in the management of children. The CRP test should be used on evidenced-based guidance at the different healthcare settings in order to attain its most clinical value. However, recent studies showed indications of inappropriate usage, especially in the primary care. Therefore, studies are needed to asses further the broad CRP utilization and its current clinical value at the different settings. The aim of this study is to determine the test frequency and CRP value in each setting. In addition, we will evaluate the CRP value for various managements, discharge advices, diagnoses, and blood culture results. Methods: This was a retrospective cohort study on children (<18 years old) visiting primary healthcare, A&E departments or being hospitalized in the oxford healthcare facilities in United Kingdom. Data on CRP test requests, treatments for A&E children, discharge advice at the A&E, diagnoses of admitted children, and blood culture were collected. Frequency distribution tables, Kruskal-Wallis test and linear mixed-effect model were used to present our results. Results: Most CRP tests were performed in the admission units (120,549 (59%)) and at the primary health care (64,176 (31%)), and there was a rising trend of test requests in these settings. The test frequency in the A&E settings was 17,926 (9%). Most children tested at the primary health care had normal CRP values (median 2 mg/L, interquartile range (IQR) 0.5-8), whereas, in the A&E and admission, the overall CRP median was slightly higher (5.2 mg/L, IQR 2-23 and 5.9 mg/L IQR 1.6-24.2, respectively). Furthermore, the CRP levels did not differ significantly per treatment or discharge decision at the A&E departments (medians ranged from 2 to 12 mg/L and from 2 to 8 mg/L, respectively). In the admission units, most diseases had similar CRP levels, and both high and low CRP values were seen in the same disease. Remarkably, appendicitis had significantly higher predicted CRP values, both at and during admission, compared to almost all other diseases (from 103.1 mg/L (95% confidence interval (CI), 100 to 106.4) at the first test moment to 148.2 mg/L 95% CI, 123 to 154) at the seventh test moment). Besides, in children with appendicitis or Crohn disease, there was about 50 mg/L decrease in CRP medians between two serial measures before discharge. Although, the median CRP levels were comparable between the gram-negative bacteria and the gram-positive bacteria (excluding coagulase-negative staphylococci) (40.6 mg/L, IQR 10.7-115.1 and 32.8 mg/L, IQR 8-127.1, respectively), certain type of bacterial species had prominently high CRP levels, especially streptococcus pneumoniae (160 mg/L, IQR 105.4-172.5). Conclusion: CRP tests are being extensively requested in the primary health care and admission units. The reasons for requesting seem to vary among the settings. Therefore, several approaches are needed in order to optimize the current utilizations. Furthermore, the maximum benefits of its clinical value can be only achieved if the test was used appropriately and on evidenced-based guidance. CRP test can contribute in the decision-making during diagnosing certain diseases, such as appendicitis and bacterial meningitis, initiating empiric antibiotics, monitoring the disease activity and discharging the child.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Holtman, dr. Gea and Berger, prof. dr. M.Y. (Marjolein) |
| Faculty: | Medical Sciences |
| Date Deposited: | 17 Apr 2023 13:07 |
| Last Modified: | 17 Apr 2023 13:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3473 |
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