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Procalcitonin as Point-of-Care Testing Modality for the Diagnosis of Pneumonia in Children With Influenza-like
Susanna Hernández-Bou1, Victoria Trenchs2, Cristina Guirado1
1Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
Insights
Procalcitonin (PCT) point-of-care testing effectively screens children with influenza-like illness and prolonged fever, guiding chest X-rays (CXRs) to rule out pneumonia and reduce radiation exposure.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Diagnostic Testing
Background:
- Influenza-like illness (ILI) in children often presents with prolonged fever, necessitating differentiation between viral and bacterial infections.
- Radiographic pneumonia is a significant concern, but chest radiography (CXR) exposes children to unnecessary radiation.
- Biomarkers are needed to guide the judicious use of CXR in this population.
Purpose of the Study:
- To assess the utility of procalcitonin (PCT) as a point-of-care test (POCT) for screening radiographic pneumonia in children with ILI and prolonged fever (>4 days).
Main Methods:
- A prospective cohort study enrolled 185 children (3 months to <18 years) with ILI and fever >4 days during the 2020 flu season.
- Point-of-care procalcitonin testing was performed.
- Chest radiography was indicated for patients with PCT levels >0.5 ng/mL.
Main Results:
- Of 185 children, 46 (24.9%) had PCT >0.5 ng/mL. Of these, 14 (31.1%) showed radiographic pneumonia on CXR (all with PCT >0.7 ng/mL).
- In 139 children (75.1%) with PCT ≤0.5 ng/mL, only two required CXR, which was unremarkable. No pneumonia was diagnosed in this group.
- PCT testing demonstrated high specificity in ruling out pneumonia.
Conclusions:
- Procalcitonin (PCT) serves as a valuable point-of-care tool for managing children with ILI and prolonged fever.
- PCT testing effectively guides decisions for chest radiography, helping to avoid unnecessary radiation exposure.
- This approach aids in the efficient diagnosis and management of pediatric pneumonia.
Objective:
To evaluate the usefulness of procalcitonin (PCT) as a point-of-care testing to screen for radiographic pneumonia among children with influenza-like illness (ILI) and prolonged fever.
Methods:
A prospective cohort study conducted at the pediatric emergency department of a tertiary hospital. Point-of-care testing for PCT was determined for 185 children aged 3 months to < 18 years with ILI and fever lasting > 4 days seen during the flu season in 2020. A chest radiograph (CXR) was performed for patients with PCT > 0.5 ng/mL.
Results:
PCT value was > 0.5 ng/mL in 46 (24.9%) patients; a CXR was ordered in all cases except one and 14 (31.1%) of them had radiographic pneumonia (all had a PCT value > 0.7 ng/mL). Among the 139 (75.1%) patients with a PCT value ≤ 0.5 ng/mL, 137 (98.6%) were managed in the outpatient with symptomatic treatment; the remaining two cases warranted a CXR which was unremarkable in both. At evolution, no radiographic pneumonia was diagnosted in any of them.
Conclusion:
PCT is a useful tool for point-of-care testing in patients with ILI and fever > 4 days to guide the indication for CXR to rule out radiographic pneumonia and helps in avoiding unnecessary radiation exposure.
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