Abstract
Background
Clinicians utilize inflammatory markers, including C-reactive protein (CRP) and erythrocyte
sedimentation rate (ESR), to identify febrile children who may have an occult serious
illness or infection.
Objectives
Our objective was to determine the relationship between invasive bacterial infections
(IBIs) and CRP and ESR in febrile children.
Methods
We performed a retrospective cross-sectional study of 1460 febrile children <21 years
of age, who presented to a single Emergency Department (ED) between 2012 and 2014
for evaluation of fever of <14 days' duration, who had both CRP and ESR obtained.
Our primary outcome was IBI, defined as growth of pathogenic bacteria from a culture
of cerebrospinal fluid or blood. We reviewed all ED encounters that occurred within
three days of the index visits for development of IBI. We examined the negative predictive
value (NPV) of CRP and ESR for IBI.
Results
Of the 1460 eligible ED encounters, the median patient age was 5.3 years [interquartile
range (IQR) 2.4–10.0 years] and 762 (50.4%) were hospitalized. The median duration
of fever was 4 days (IQR 1–7 days). Overall, 20 had an IBI (20/1460; 1.4%, 95% confidence
interval (CI) 0.9–2.1%). None of those with a normal CRP (NPV 273/273; 100%, 95% CI
98.6–100%) or a normal ESR (NPV 486/486; 100%, 95% CI 99.2–100%) had an IBI.
Conclusions
In our cross-sectional study of febrile children, IBI was unlikely with either a normal
CRP or ESR. Inflammatory markers could be used to assist clinical decision-making
while awaiting results of bacterial cultures.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study.BMJ. 2013; 346: f1706https://doi.org/10.1136/bmj.f1706
- Bacterial meningitis in the United States, 1998–2007.N Engl J Med. 2011; 364: 2016-2025https://doi.org/10.1056/NEJMoa1005384
- C reactive protein in the evaluation of febrile illness.Arch Dis Child. 1986; 61: 24-29
- C-reactive protein in early detection of bacteremic versus viral infections in immunocompetent and compromised children.J Pediatr. 1988; 113: 641-646
- A predictive model to estimate the risk of serious bacterial infections in febrile infants.Eur J Pediatr. 1996; 155: 468-473
- DrT - document review tools.
- Mastering regular expressions.O'Reilly, 2006
- Pediatric biomedical informatics.vol. 2. Springer Netherlands, Dordrecht2012https://doi.org/10.1007/978-94-007-5149-1
- An introduction to natural language processing: how you can get more from those electronic notes you are generating.Pediatr Emerg Care. 2015; 31: 536-541https://doi.org/10.1097/PEC.0000000000000484
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174https://doi.org/10.2307/2529310
- Rating scales, scales of measurement, issues of reliability: resolving some critical issues for clinicians and researchers.J Nerv Ment Dis. 2006; 194: 557-564https://doi.org/10.1097/01.nmd.0000230392.83607.c5
- C-reactive protein versus erythrocyte sedimentation rate, white blood cell count and alkaline phosphatase in diagnosing bacteraemia in bone and joint infections.J Paediatr Child Health. 2013; 49: E189-E192https://doi.org/10.1111/jpc.12122
- A score identifying serious bacterial infections in children with fever without source.Pediatr Infect Dis J. 2008; 27: 654-656https://doi.org/10.1097/INF.0b013e318168d2b4
- C-reactive protein in febrile children 1 to 36 months of age with clinically undetectable serious bacterial infection.Pediatrics. 2001; 108: 1275-1279
- Validity of the quick-read C-reactive protein test in the prediction of bacterial pneumonia in the pediatric emergency department.Eur J Emerg Med. 2008; 15: 158-161https://doi.org/10.1097/MEJ.0b013e3282f12f52
- Procalcitonin as a marker of serious bacterial infections in febrile children younger than 3 years old.Acad Emerg Med. 2014; 21: 171-179https://doi.org/10.1111/acem.12316
- Use of procalcitonin assays to predict serious bacterial infection in young febrile infants.JAMA Pediatr. 2016; 170: 62-69https://doi.org/10.1001/jamapediatrics.2015.3210
- Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis.Ann Emerg Med. 2012; 60: 591-600https://doi.org/10.1016/j.annemergmed.2012.05.027
- C-reactive protein, procalcitonin, and the lab-score for detecting serious bacterial infections in febrile children at the emergency department: a prospective observational study.Pediatr Infect Dis J. 2014; 33: 273-279https://doi.org/10.1097/INF.0000000000000466
- Identifying febrile young infants with bacteremia: is the peripheral white blood cell count an accurate screen?.Ann Emerg Med. 2003; 42: 216-225https://doi.org/10.1067/mem.2003.299
- Clinical applications of C-reactive protein in pediatrics.Pediatr Infect Dis J. 1997; 16 ([quiz 746-7]): 735-746
- High-sensitivity C-reactive protein and erythrocyte sedimentation rate in systemic lupus erythematosus.Lupus. 2011; 20: 588-597https://doi.org/10.1177/0961203310393378
- C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin.J Rheumatol. 2012; 39: 728-734https://doi.org/10.3899/jrheum.111044
- Erythrocyte sedimentation rate and C-reactive protein levels are poorly correlated with clinical measures of disease activity in rheumatoid arthritis, systemic lupus erythematosus and osteoarthritis patients.Clin Exp Rheumatol. 2008; 26: 814-819
- Frequency and causes of C-reactive protein and erythrocyte sedimentation rate disagreements in adults.Int J Rheum Dis. 2015; 18: 29-32https://doi.org/10.1111/1756-185X.12537
- C-reactive protein in orthopaedic surgery.Acta Chir Orthop Traumatol Cech. 2015; 82: 327-331
- Erythrocyte sedimentation rate and C-reactive protein values in patients with total hip arthroplasty.Clin Orthop Relat Res. 1987; : 238-246
- C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) or both? A systematic evaluation in pediatric ulcerative colitis.J Crohns Colitis. 2011; 5: 423-429https://doi.org/10.1016/j.crohns.2011.05.003
- Correlation of erythrocyte sedimentation rate and C-reactive protein with pediatric inflammatory bowel disease activity.J Pediatr Gastroenterol Nutr. 2016; 1https://doi.org/10.1097/MPG.0000000000001444
- HHS public access.10. 2016: 787-793https://doi.org/10.1002/jhm.2441.Accuracy
- Complexity and severity of pediatric patients treated at United States emergency departments.J Pediatr. 2017; 186: 145-149.e1https://doi.org/10.1016/j.jpeds.2017.03.035
- Patients visiting multiple emergency departments: patterns, costs, and risk factors.Acad Emerg Med. 2017; 24: 1349-1357https://doi.org/10.1111/acem.13304
- Decline in invasive pneumococcal disease after the introduction of protein–polysaccharide conjugate vaccine.N Engl J Med. 2003; 348: 1737-1746https://doi.org/10.1056/NEJMoa022823
- Invasive pneumococcal disease after implementation of 13-valent conjugate vaccine.Pediatrics. 2014; 134: 210-217https://doi.org/10.1542/peds.2014-0473
Article Info
Publication History
Published online: November 08, 2018
Accepted:
November 6,
2018
Received in revised form:
October 2,
2018
Received:
May 16,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
