Impact of procalcitonin on the management of children aged 1 to 36 months presenting with fever without source: A randomized controlled trial☆
Received 2 February 2009; received in revised form 11 February 2009; accepted 11 February 2009. published online 23 November 2009.
Abstract
Objective
The aim of the study was to evaluate the impact of procalcitonin (PCT) measurement on antibiotic use in children with fever without source.
Method
Children aged 1 to 36 months presenting to a pediatric emergency department (ED) with fever and no identified source of infection were eligible to be included in a randomized controlled trial. Patients were randomly assigned to 1 of 2 groups as follows: PCT+ (result revealed to the attending physician) and PCT− (result not revealed). Patients from both groups also had complete blood count, blood culture, urine analysis, and culture performed. Chest radiography or lumbar puncture could be performed if required.
Results
Of the 384 children enrolled and equally randomized into the PCT+ and PCT− groups, 62 (16%) were diagnosed with a serious bacterial infection (urinary tract infection, pneumonia, occult bacteremia, or bacterial meningitis) by primary ED investigation. Ten were also found to be neutropenic (<500 × 106/L). Of the remaining undiagnosed patients, 14 (9%) of 158 received antibiotics in the PCT+ group vs 16 (10%) of 154 in the PCT− group (Δ −2%; 95% confidence interval [CI], −8 to 5). A strategy to treat all patients with PCT of 0.5 ng/mL or greater with prophylactic antibiotic in this group of patients would have resulted in an increase in antibiotic use by 24% (95% CI, 15-33).
Conclusion
Semiquantitative PCT measurement had no impact on antibiotic use in children aged 1 to 36 months who presented with fever without source. However, a strategy to use prophylactic antibiotics in all patients with abnormal PCT results would have resulted in an increase use of antibiotics.
aDivision of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Quebec, Canada H3T 1C5
bDivision of Clinical Pharmacology and Toxicology, Department of Pediatrics, CHU Sainte-Justine, Quebec, Canada H3T 1C5
cDivision of Emergency Medicine, Children's Hospital HUG, Geneva 1205, Switzerland
dDepartment of Biochemistry, CHU Sainte-Justine, Quebec, Canada H3T 1C5
Corresponding author. Department of Pediatrics, CHU Ste-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montréal, Canada Qc H3T 1C5. Tel.: +1 514 345 4931x6276; fax: +1 514 345 4823.
Presented in part at the Pediatric Academic Societies Annual Meeting, Honolulu, Hawaii, May 2008, and the Society for Academic Emergency Medicine Annual Meeting, Washington, DC, May 2008.
☆ We received 200 PCT-Q free of charge from Brahms (Germany).
ABSTRACT