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C-reactive protein point-of-care testing in acutely ill children: a mixed methods study in primary care
Ann Van den Bruel1, Caroline Jones1, Matthew Thompson2
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
Point-of-care C-reactive protein (CRP) testing is feasible and acceptable for acutely ill children in primary care. However, its impact on antibiotic prescribing requires general practitioner acceptance of its diagnostic value.
Area of Science:
- Pediatric primary care
- Diagnostic testing
- Infectious disease management
Background:
- Point-of-care C-reactive protein (CRP) testing reduces antibiotic prescribing in adults with acute respiratory infection.
- The acceptability and impact of CRP testing in children remain unknown.
Purpose of the Study:
- To determine the acceptability and impact of CRP testing in acutely ill children presenting to primary care.
Main Methods:
- A mixed-methods study combining an observational cohort, a nested randomized controlled trial, and a qualitative study.
- Recruitment of children with acute illness and fever (≥38°C) in general practice out-of-hours services.
- Inclusion of parental and clinical staff perspectives through a nested qualitative study.
Main Results:
- Informed consent was obtained for 67.3% of children; finger-prick testing was a minor factor in declining participation for some.
- Parents and clinical staff found CRP testing acceptable, reporting minor and transient pain.
- General practitioner views on the utility of CRP testing were inconsistent.
Conclusions:
- Point-of-care CRP testing is feasible and likely acceptable for children in primary care settings.
- Widespread adoption to reduce antibiotic prescribing and hospital referrals is contingent on general practitioner acceptance of CRP's diagnostic value in pediatric cases.
Background:
Point-of-care C-reactive protein (CRP) testing of adults with acute respiratory infection in primary care reduces antibiotic prescribing by 22%. The acceptability and impact of CRP testing in children is unknown
Objective:
To determine the acceptability and impact of CRP testing in acutely ill children.
Design:
Mixed methods study comprising an observational cohort with a nested randomised controlled trial and embedded qualitative study.
Subjects And Setting:
Children presenting with an acute illness to general practice out-of-hours services; children with a temperature ≥38°C were randomised in the nested trial; parents and clinical staff were invited to the qualitative study.
Main Outcomes:
Informed consent rates; parental and staff views on testing.
Results:
Consent to involvement in the study was obtained for 200/297 children (67.3%, 95% CI 61.7% to 72.6%); the finger-prick test might have been a contributory factor for 63 of the 97 children declining participation but it was cited as a definite factor in only 10 cases. None of the parents or staff raised concerns about the acceptability of testing, describing the pain caused as minor and transient. General practitioner views on the utility of the CRP test were inconsistent.
Conclusions:
CRP point-of-care testing in children is feasible in primary care and is likely to be acceptable. However, it will not reduce antibiotic prescribing and hospital referrals until general practitioners accept its diagnostic value in children.
Trial Registration Number:
ISRCTN 69736109.
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