Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
BMC Pediatr. 2012 Sep 3;12:140. doi: 10.1186/1471-2431-12-140.
C-reactive protein (CRP) is widely used to detect bacterial infection in children. We investigated the impact of CRP test results on decision-making and summarized the evidence base (EB) of CRP testing.
We collected information from the hospital records of 91 neonates with suspected sepsis and of 152 febrile children with suspected infection on the number of ordered CRP tests, the number of EB-CRP tests, and the impact of the test results on decision-making. CRP diagnostic accuracy studies focusing on pediatric infections were reviewed critically. The main outcomes were the proportion of CRP tests that were EB and the proportion of tests that affected decision-making. A secondary outcome was the overall one-year expenditure on CRP testing.
The current EB for CRP testing in pediatric infections is weak and suggests that CRP is of low diagnostic value. Approximately 54.8% of tests performed for suspected neonatal sepsis and 28% of tests performed for other infections were EB; however, the results of only 12.9% of neonatal sepsis tests and of 29.9% of tests on children with other infections informed decision-making. The one-year overall cost for CRP testing and related health care was $26,715.9.
The routine ordering of CRP for children with infections is based on weak evidence. The impact of the CRP test results on decision-making is rather small, and CRP ordering may contribute to unnecessary health care expenditures. Better quality research is needed to definitively determine the diagnostic accuracy of CRP levels in children with infections.
C 反应蛋白（CRP）广泛用于检测儿童的细菌感染。我们研究了 CRP 检测结果对决策的影响，并总结了 CRP 检测的循证医学证据基础（EB）。
我们从 91 例疑似败血症的新生儿和 152 例疑似感染的发热儿童的医院记录中收集了有关 CRP 检测数量、EB-CRP 检测数量以及检测结果对决策影响的信息。我们对重点关注儿科感染的 CRP 诊断准确性研究进行了批判性评价。主要结局是 EB 中 CRP 检测的比例和影响决策的检测比例。次要结局是 CRP 检测的总体一年支出。
目前儿科感染 CRP 检测的 EB 较弱，提示 CRP 的诊断价值较低。疑似新生儿败血症的检测中，约有 54.8%是 EB，其他感染的检测中，有 28%是 EB；但只有 12.9%的新生儿败血症检测和 29.9%的其他感染儿童检测结果影响了决策。CRP 检测和相关医疗保健的一年总支出为 26715.9 美元。
感染患儿常规 CRP 检测的依据是薄弱的证据。CRP 检测结果对决策的影响相当小，CRP 检测可能会导致不必要的医疗支出。需要更好的质量研究来明确确定 CRP 水平在儿童感染中的诊断准确性。
