基层医疗中即时 C 反应蛋白检测在儿童急性感染中的应用：一项观察性研究。
Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study.
机构信息
EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Department of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
出版信息
BMC Pediatr. 2022 Nov 4;22(1):633. doi: 10.1186/s12887-022-03677-5.
BACKGROUND
Acute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients' characteristics, care setting, preliminary diagnosis, and management.
METHODS
A prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium.
RESULTS
In this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was 10 mg/L (IQR < 5-29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13-113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10-58) compared to 7 mg/L (IQR < 5-19) when they were not prescribed.
CONCLUSION
A low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02024282 (registered on 31/12/2013).
背景
急性感染是儿童就诊初级保健的常见原因。严重感染很少见，但区分它们与自限性疾病仍然具有挑战性。这可能导致抗生素的不适当使用。即时 C 反应蛋白（CRP）检测用于指导成人抗生素的使用。然而，在儿童中，其使用仍不清楚。本研究旨在评估即时 CRP 检测水平与患者特征、护理环境、初步诊断和管理的关系。
方法
在比利时的门诊环境中，对患有急性感染的儿童进行了一项前瞻性观察性研究。
结果
本研究共分析了 8280 例病例，其中 6552 例有即时 CRP 值。共有 276 名医生参与。患者的中位年龄为 1.98 岁（IQR 0.97-4.17），37%的儿童就诊于全科医生，33%就诊于儿科门诊，30%就诊于急诊室。共发现 131 种不同的初步诊断，急性上呼吸道感染最为常见。6%（n=513）的患者被诊断为严重感染。最常见的严重感染是肺炎。所有感染发作中有 28%（n=2030）的患者使用了抗生素。所有感染发作的中位 CRP 为 10mg/L（IQR＜5-29）。5 岁以下儿童和儿科医生就诊的儿童 CRP 中位数较高。严重感染患者的中位 CRP 为 21mg/L（IQR 6-63.5）。肺炎的中位 CRP 为 48mg/L（IQR 13-113）。在使用抗生素的病例中，中位 CRP 水平为 29mg/L（IQR 10-58），而未使用抗生素的病例中为 7mg/L（IQR＜5-19）。
结论
即时 CRP 作为一种单独的工具似乎不足以排除严重感染，但当它整合到临床决策规则中时，其评估严重感染的潜力可能会增加。
试验注册
ClinicalTrials.gov 标识符：NCT02024282（于 2013 年 12 月 31 日注册）。
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