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Overview of Pediatric Procalcitonin Testing Patterns in a Tertiary Care Children's Hospital
Sheila Swartz1, Natalya Beneschott2, Tracy Zembles1
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Procalcitonin (PCT) testing in children is frequently used to detect bacterial infections. However, this retrospective study found significant overuse and inappropriate use of PCT tests in hospitalized children, suggesting a need for better diagnostic stewardship.
Area of Science:
- Pediatric Medicine
- Clinical Pathology
- Infectious Diseases
Background:
- Procalcitonin (PCT) testing is increasingly relied upon to diagnose bacterial infections in hospitalized patients.
- The appropriate utilization of PCT testing, particularly in pediatric populations, requires careful evaluation.
Purpose of the Study:
- To retrospectively analyze the patterns of PCT testing in children admitted to a tertiary care children's hospital.
- To identify potential areas for improvement in diagnostic stewardship of PCT testing.
Main Methods:
- Retrospective review of medical records for children (<18 years) hospitalized between 2017 and 2019.
- Analysis of 4135 PCT levels from 1530 pediatric patients, examining testing frequency, results, and patient characteristics.
Main Results:
- Pediatric intensive care units accounted for a disproportionately high percentage of PCT tests (41.4%).
- A small group of patients (2%) accounted for a significant portion of tests (20%), with high repeat testing rates.
- PCT testing was performed in many children with symptoms not typically indicated for its use, such as skin complaints.
Conclusions:
- Significant variations in PCT testing across hospital services were observed.
- Inappropriate repeat testing and testing in non-indicated cases highlight opportunities for diagnostic stewardship interventions.
- Optimizing PCT utilization can improve resource allocation and diagnostic accuracy in pediatric care.
Abstract:
The use of procalcitonin (PCT) has grown over the past decade with increasing reliance on the test to rule out bacterial infection. We retrospectively reviewed the medical records of children <18 years old hospitalized at a tertiary care children's hospital from 2017 to 2019 who had PCT testing performed during their admission. Of 4135 PCT levels collected on 1530 children, 982 (23.7%) were diagnostically low and 1993 (48.1%) were diagnostically elevated. Pediatric intensive care, with 6% of total hospital patients, obtained 41.4% of tests. Thirty-one (2%) patients had an average of 27 PCT levels per patient, accounting for 20% of all tests. Many children had symptoms for which testing is not indicated (eg, skin complaints). The differences in PCT testing by service, inappropriate patterns of repeat testing, and testing performed in patients for whom it is not indicated may identify targets for diagnostic stewardship.
