Application of procalcitonin in pediatric emergency and critical care settings

This expert consensus on the clinical application of procalcitonin (PCT) in pediatric emergency and critical care was convened by the Taiwan Society of Pediatric Emergency Medicine (TSPEM) and formulated by a committee of 14 leading experts. In pediatric emergency and critical care medicine, distinguishing between bacterial and viral etiologies remains a significant challenge, as clinical symptoms often lack specificity. While traditional biomarkers such as white blood cell count (WBC) and Creactive protein (CRP) provide reference values, they possess limitations regarding diagnostic timeliness and accuracy. In contrast, PCT serves as a specific biomarker for bacterial infections with superior kinetic advantages, rising rapidly within 3 to 6 hours of infection. It demonstrates greater sensitivity than CRP in the early detection of bacterial infections and in reflecting disease severity. This consensus recommends PCT as a vital adjunctive diagnostic tool, particularly for the early diagnosis and risk stratification of lower respiratory tract infections, bacterial meningitis, and sepsis. Specifically within the Pediatric Intensive Care Unit (PICU), PCT levels are valuable for monitoring disease progression and assessing the risk of sepsis-associated organ dysfunction. Furthermore, PCT plays a pivotal role in antimicrobial stewardship by providing objective guidance for the initiation and deescalation of antibiotic therapy, thereby effectively reducing unnecessary antibiotic exposure and mitigating the risk of antimicrobial resistance. Although PCT entails higher costs, studies indicate that its combination with CRP enhances diagnostic value. The committee emphasizes that PCT should be utilized as an "adjunctive aid" rather than a sole determinant of clinical decision-making. Clinicians must integrate PCT results with the patient's overall clinical presentation and employ dynamic serial monitoring to optimize care quality and therapeutic outcomes in pediatric emergency and critical care settings.