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C-Reactive Protein and the Outcome of a Pediatric Emergency Department 7 Days Revisit
Miguel Glatstein1, Lotan Salamon1, Gili Palnizky Soffer1
1From the Division of Pediatrics Department, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
High C-reactive protein (CRP) levels in children visiting the pediatric emergency department (PED) do not predict outcomes for a subsequent PED visit within 7 days. Further research is needed to understand repeat PED visit predictors.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Biomarkers
- Quality of Care Metrics
Background:
- Pediatric emergency department (PED) return visits are key quality indicators.
- C-reactive protein (CRP) is a common inflammatory biomarker used in PEDs.
- Understanding predictors of repeat PED visits is crucial for patient-centered care.
Purpose of the Study:
- To evaluate clinical outcomes for children with high CRP levels (≥150 mg/L) at initial PED visits.
- To determine if elevated CRP predicts outcomes at a subsequent PED visit within 7 days.
Main Methods:
- Historical cohort study of pediatric patients with febrile illness and CRP ≥150 mg/L between 2007-2017.
- Analysis of laboratory values, diagnoses, and clinical outcomes for patients with return visits within 7 days.
Main Results:
- 136 index visits were analyzed.
- Most repeat visits (84.6%) resulted in discharge; 15.4% required admission.
- No significant difference in diagnosis or CRP levels between discharged and admitted patients.
Conclusions:
- High CRP concentrations in children do not appear to predict outcomes for repeat PED visits within 7 days.
- Inflammatory response intensity, indicated by CRP, is not a reliable predictor of short-term outcomes in this cohort.
Background:
Pediatric emergency department (PED) return visits represent an important quality of care metric and constitute a patient-centered outcome. C-reactive protein (CRP) is an inflammatory biomarker that is commonly used as screening tool in the PED. In this study, we assessed the clinical outcomes of children whose levels of CRP are 150 mg/L or higher at the initial PED visit and if such levels could be useful in predicting outcomes at a second PED visit.
Methods:
A historical cohort study of all patients who visited the PED between July 2007 and June 2017 and had a CRP value of 150 mg/L or greater in the setting of a febrile illness. Data of patients with a return visit to the PED within 7 days were assessed for an association between laboratory values, diagnosis and clinical outcome.
Results:
One hundred thirty-six index visits were included in this study. One hundred fifteen (84.6%) of the revisits were discharged after their second visit, and 21 (15.4%) were admitted to the inpatient unit. Admitted patients did not differ from patients who were discharged home in diagnosis and CRP levels, but a difference in white blood cell and absolute neutrophil counts was observed.
Conclusions:
The intensity of the inflammatory response, as expressed by the high concentrations of CRP in children, does not seem to predict the outcome at a repeat PED visit within 7 days.
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