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Impact of C-reactive protein test results on evidence-based decision-making in cases of bacterial infection
Mona Nabulsi1, Abeer Hani, Maria Karam
1Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon. mn04@aub.edu.lb
Insights
C-reactive protein (CRP) testing in children has weak evidence supporting its diagnostic value for infections. CRP results minimally impact clinical decisions, potentially leading to unnecessary healthcare costs.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Health Economics
Background:
- C-reactive protein (CRP) is commonly used to diagnose bacterial infections in children.
- The evidence base for CRP testing in pediatric infections requires critical evaluation.
Purpose of the Study:
- To investigate the impact of C-reactive protein (CRP) test results on clinical decision-making in pediatric infections.
- To summarize the existing evidence base (EB) for CRP testing in children.
- To assess the cost-effectiveness of CRP testing in pediatric care.
Main Methods:
- Retrospective analysis of hospital records for 91 neonates with suspected sepsis and 152 febrile children.
- Critical review of CRP diagnostic accuracy studies in pediatric infections.
- Evaluation of the proportion of evidence-based (EB) CRP tests and their impact on decision-making.
Main Results:
- The evidence base for CRP testing in pediatric infections is weak, indicating low diagnostic value.
- Only 54.8% of neonatal sepsis tests and 28% of other pediatric infection tests were evidence-based (EB).
- CRP results influenced decision-making in only 12.9% of neonatal sepsis cases and 29.9% of other pediatric infections, with annual costs of $26,715.9.
Conclusions:
- Routine CRP ordering for pediatric infections is supported by weak evidence.
- CRP test results have a limited impact on clinical decisions, potentially increasing healthcare expenditure.
- Higher quality research is necessary to establish definitive diagnostic accuracy of CRP in children.
Background:
C-reactive protein (CRP) is widely used to detect bacterial infection in children. We investigated the impact of CRP test results on decision-making and summarized the evidence base (EB) of CRP testing.
Methods:
We collected information from the hospital records of 91 neonates with suspected sepsis and of 152 febrile children with suspected infection on the number of ordered CRP tests, the number of EB-CRP tests, and the impact of the test results on decision-making. CRP diagnostic accuracy studies focusing on pediatric infections were reviewed critically. The main outcomes were the proportion of CRP tests that were EB and the proportion of tests that affected decision-making. A secondary outcome was the overall one-year expenditure on CRP testing.
Results:
The current EB for CRP testing in pediatric infections is weak and suggests that CRP is of low diagnostic value. Approximately 54.8% of tests performed for suspected neonatal sepsis and 28% of tests performed for other infections were EB; however, the results of only 12.9% of neonatal sepsis tests and of 29.9% of tests on children with other infections informed decision-making. The one-year overall cost for CRP testing and related health care was $26,715.9.
Conclusions:
The routine ordering of CRP for children with infections is based on weak evidence. The impact of the CRP test results on decision-making is rather small, and CRP ordering may contribute to unnecessary health care expenditures. Better quality research is needed to definitively determine the diagnostic accuracy of CRP levels in children with infections.
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