From the Division of Pediatrics Department, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Pediatr Emerg Care. 2022 Sep 1;38(9):453-455. doi: 10.1097/PEC.0000000000002634. Epub 2022 Feb 21.
Pediatric emergency department (PED) return visits represent an important quality of care metric and constitute a patient-centered outcome. C-reactive protein (CRP) is an inflammatory biomarker that is commonly used as screening tool in the PED. In this study, we assessed the clinical outcomes of children whose levels of CRP are 150 mg/L or higher at the initial PED visit and if such levels could be useful in predicting outcomes at a second PED visit.
A historical cohort study of all patients who visited the PED between July 2007 and June 2017 and had a CRP value of 150 mg/L or greater in the setting of a febrile illness. Data of patients with a return visit to the PED within 7 days were assessed for an association between laboratory values, diagnosis and clinical outcome.
One hundred thirty-six index visits were included in this study. One hundred fifteen (84.6%) of the revisits were discharged after their second visit, and 21 (15.4%) were admitted to the inpatient unit. Admitted patients did not differ from patients who were discharged home in diagnosis and CRP levels, but a difference in white blood cell and absolute neutrophil counts was observed.
The intensity of the inflammatory response, as expressed by the high concentrations of CRP in children, does not seem to predict the outcome at a repeat PED visit within 7 days.
儿科急诊部（PED）复诊是衡量医疗质量的一个重要指标，也是患者为中心的一个结果。C-反应蛋白（CRP）是一种炎症生物标志物，常用于 PED 的筛查工具。本研究评估了 CRP 初始水平在 150mg/L 或以上的患儿的临床结局，以及其水平是否可用于预测第二次 PED 就诊的结局。
对 2007 年 7 月至 2017 年 6 月期间在 PED 就诊且发热时 CRP 值在 150mg/L 或以上的所有患者进行回顾性队列研究。评估了在 7 天内再次 PED 就诊的患者的实验室值、诊断和临床结局之间的相关性。
本研究共纳入 136 次就诊。115 次（84.6%）复诊后出院，21 次（15.4%）住院。与出院回家的患者相比，住院患者的诊断和 CRP 水平无差异，但白细胞和绝对中性粒细胞计数有差异。
在 7 天内再次 PED 就诊时，患儿 CRP 浓度较高表明炎症反应强度，但似乎不能预测其结局。
