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Trends in C reactive protein testing: a retrospective cohort study in paediatric ambulatory care settings
Mohammed Alkhmees1,2, Ann Van Den Bruel3, Gail Hayward4
1Department of Primary and Long Term Care, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.
Insights
C-reactive protein (CRP) testing is increasing in UK pediatric primary care and A&E. While primary care shows rising CRP tests with stable results, A&E sees more admissions, even with low CRP levels.
Area of Science:
- Pediatric Ambulatory Care
- Clinical Pathology
- Healthcare Management
Background:
- C-reactive protein (CRP) testing is a common diagnostic tool in pediatric care.
- Understanding current CRP testing practices is crucial for optimizing resource allocation and patient management.
- Variations in testing and interpretation exist between primary care and emergency departments.
Purpose of the Study:
- To investigate C-reactive protein (CRP) testing patterns in children across British primary care and accident and emergency (A&E) settings.
- To analyze trends in CRP test frequency and referral/admission rates based on CRP levels.
- To evaluate the clinical utility of CRP testing in different pediatric ambulatory care environments.
Main Methods:
- Retrospective cohort study of children under 18 years old in Oxfordshire from 2007-2021.
- Analysis of CRP test requests in primary care and A&E departments.
- Evaluation of referral and admission patterns correlated with low (<20 mg/L), intermediate, and high (≥80 mg/L) CRP levels.
Main Results:
- Over 15 years, 91,540 CRP tests were performed on 63,226 children, with increasing trends in both primary care (3.0% annual change) and A&E (11.5% annual change).
- In primary care, 95.8% of tests were low CRP, with 99.0% managed at home; higher CRP levels significantly increased referral odds.
- In A&E, 71.5% of tests were low CRP, yet 42.5% of these children were admitted; high CRP levels increased admission odds (OR 1.90).
Conclusions:
- Pediatric CRP test requests are rising in ambulatory settings, but intermediate/high results remain stable in primary care.
- Low CRP values in primary care correlate with home management, whereas low CRP in A&E still leads to significant hospital admissions.
- CRP testing trends and outcomes differ notably between primary care and A&E, highlighting the need for setting-specific interpretation guidelines.
Objectives:
This study aims to investigate C reactive protein (CRP) testing practices in paediatric ambulatory care across British primary care and accident and emergency (A&E) departments.
Design, Setting, Participants:
This retrospective cohort study included children <18 years old having ≥1 CRP test at primary care or A&E departments in Oxfordshire between 2007 and 2021.
Outcomes:
We estimated the frequency and annual changes in CRP testing in both settings and evaluated referral and admission patterns based on CRP levels: low (<20 mg/L), intermediate or high (≥80 mg/L).
Results:
Over 15 years, 91 540 CRP tests were requested in 63 226 children, with 33 882 (53.6%) in primary care and 29 344 (46.4%) in A&E. Both settings showed rising trends in test requests, with average annual percentage change of 3.0% (95% CI 1.2% to 4.7%) in primary care and 11.5% (95% CI 8.6% to 14.6%) in A&E. The proportion of intermediate/high-test results remained stable. In primary care, 50 709 (95.8%) of CRP tests were <20 mg/L, with 99.0% of these children managed at home. High and intermediate CRP values increased odds of referral versus low CRP (OR adjusted for age=21.80; 95% CI 16.49 to 28.81 and 4.77; 3.78 to 6.02, respectively). At A&E, 27 610 (71.5%) children had CRP<20 mg/L, of whom 42.5% were admitted while 3776 (9.8%) had CRP≥80 mg/L with 57.9% admission rate. High and intermediate CRP values increased odds of admission versus low CRP (OR adjusted for age=1.90; 95% CI 1.78 to 2.04 and 1.39; 1.32 to 1.46, respectively).
Conclusion:
There are rising trends of CRP test requests in paediatric ambulatory care settings, with no evidence of increases in proportion of intermediate/high-test results in primary care. Low CRP values at primary care were linked to children managed at home, while almost half of children with low CRP values at A&E were admitted to the hospital.
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