C-反应蛋白检测结果对细菌性感染病例循证决策的影响。

Impact of C-reactive protein test results on evidence-based decision-making in cases of bacterial infection.

机构信息

Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

出版信息

BMC Pediatr. 2012 Sep 3;12:140. doi: 10.1186/1471-2431-12-140.

DOI:10.1186/1471-2431-12-140

PMID:22943554

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3457842/

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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）。

方法

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。

结果

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。