Procalcitonin use in febrile children attending European emergency departments: a prospective multicenter study

Studies on procalcitonin (PCT) for identifying sepsis were published as early as 1993 and since then, PCT has been the topic of over 8,500 studies. Several studies show PCT to be superior to CRP in differentiating invasive infections such as sepsis from viral infections, especially early in the disease course. However, its actual use in clinical practice is poorly documented. Our aim was to study the use of PCT in febrile children attending the ED across Europe and compare this to the use of CRP.

The MOFICHE/PERFORM study, a prospective multicenter study, took place at 12 European EDs in eight countries and included febrile children < 18 years. In this secondary analysis of nine participating EDs that used PCT, descriptive analyses were performed, describing the use of PCT in all febrile children and for different age groups, foci of fever and fever duration.

In total, 31,612 pediatric febrile episodes were available for analyses. Blood tests were performed in 15,812 (50.0%, range 9.6-92.6%)) febrile episodes. CRP was included in 98.3% of blood tests (range between hospitals 80-100%), while PCT was included in only 3.9% (range 0.1-86%). PCT was most often performed in children below 3 months (12.0% versus 3.6% in older children, p < 0.001). PCT was used slightly more often in children with fever less than 24 h in comparison to children with a duration of fever ≥ 24 h (4.9% versus 3.4%, p < 0.001). Regarding clinical alarming signs, PCT was used most often in children with meningeal signs (7.0%) or a non-blanching rash (10.9%).

Actual PCT use in febrile children at European EDs is limited and varies largely between hospitals. Possible explanations include lack of guidelines, limited availability, higher costs and lack of readiness to adapt new clinical strategies.