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Comparison of Procalcitonin With Commonly Used Biomarkers and Algorithms for Evaluating Suspected Pediatric
Lyndsey van der Laan1,2, Nakia Gaines1,2, Ngoc Van Horn1,2
1Children's Health System of Texas, Dallas, TX.
Insights
Procalcitonin (PCT) aids in distinguishing infectious from non-infectious musculoskeletal conditions in children. Combining PCT with other markers like CRP and temperature significantly improves diagnostic accuracy for deep infections.
Area of Science:
- Pediatric infectious diseases
- Musculoskeletal infections
- Biomarker research
Background:
- Differentiating infectious from non-infectious pediatric musculoskeletal conditions is challenging.
- Clinical predictive algorithms have limitations in this diagnostic process.
- Procalcitonin (PCT) is a proposed biomarker for infection detection.
Purpose of the Study:
- Evaluate the adoption and clinical utility of PCT in initial evaluations for suspected pediatric musculoskeletal infections.
- Assess the diagnostic test characteristics of PCT and other common parameters.
- Determine the accuracy of algorithms combining multiple parameters.
Main Methods:
- Prospective enrollment of children with suspected musculoskeletal infections from July 2020 to November 2021.
- Categorization into deep infection, superficial infection, and non-infection cohorts post-treatment.
- Univariate and multivariate logistic regression analysis of clinical parameters and diagnoses.
- Assessment of individual and aggregated parameter test characteristics.
Main Results:
- Procalcitonin (PCT) was utilized in 72.9% of initial evaluations, with increasing adoption over time.
- PCT >0.1 ng/mL independently predicted deep infection with 84.7% accuracy.
- Combining PCT with white blood cell count, C-reactive protein (CRP), and absolute neutrophil count showed varying accuracy.
- Aggregated parameters including PCT, CRP, erythrocyte sedimentation rate, and temperature improved diagnostic accuracy to 89.4%.
Conclusions:
- Procalcitonin (PCT) shows potential as a valuable biomarker in assessing pediatric musculoskeletal infections.
- A systematic approach combining multiple parameters enhances diagnostic accuracy and aids clinical judgment.
- Specific thresholds for PCT, ESR, CRP, and temperature can help reassure clinicians regarding the likelihood of deep musculoskeletal infection.
Introduction:
It is difficult to distinguish between children with infectious versus noninfectious conditions of the musculoskeletal system during initial evaluation. Clinical predictive algorithms potentially support this effort but not without limitations. Procalcitonin (PCT) has been proposed as a biomarker to help differentiate infection from noninfection. This study evaluates the adoption and utility of PCT during initial infection evaluations and assesses test characteristics of commonly used parameters and algorithms.
Methods:
PCT was introduced for initial laboratory evaluation of the suspected musculoskeletal infection. Prospective enrollment occurred from July 2020 to November 2021 with 3 cohorts established after a retrospective review of final diagnoses at the end of treatment: 1) deep infection, 2) superficial infection, and 3) noninfection. Univariate and multivariate logistic regression analysis of parameters and diagnoses was performed. Test characteristics of individual and aggregated parameters were assessed.
Results:
Among 258 children evaluated, 188 (72.9%) had PCT drawn during the evaluation. An increase of PCT acquisition from 67.8% to 82.4% occurred over the study timeframe. Eighty-five children were prospectively studied, including those with deep infection (n=21); superficial infection (n=10), and noninfection (n=54). Test characteristics of parameters showed accuracy ranging from 48.2% to 85.9%. PCT >0.1 ng/mL independently predicted deep infection in 84.7% of cases, outperforming white blood cell, C-reactive protein (CRP), and absolute neutrophil count. Using study thresholds for CRP, erythrocyte sedimentation rate, PCT, and Temp improved accuracy to 89.4%.
Conclusions:
PCT is a potentially useful biomarker during the initial assessment of children suspected to have a musculoskeletal infection. Systematic evaluation using a combination of parameters improves the accuracy of assessment and assists predictive judgment under uncertainty. PCT <0.1 ng/mL, erythrocyte sedimentation rate <18 mm/hr, CRP <3.3 mg/dL, and temperature <37.8°C should reasonably reassure clinicians that deep musculoskeletal infection is less likely, given the high negative predictive value and collective accuracy of these parameters.
Level Of Evidence:
Level III - Retrospective cohort comparison.
