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Research ArticleOriginal Research

C-Reactive Protein Level as Diagnostic Marker in Young Febrile Children Presenting in a General Practice Out-of-Hours Service

Marijke Kool, Gijs Elshout, Bart W. Koes, Arthur M. Bohnen and Marjolein Y. Berger
The Journal of the American Board of Family Medicine July 2016, 29 (4) 460-468; DOI: https://doi.org/10.3122/jabfm.2016.04.150315
Marijke Kool
the Department of General Practice, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands (MK, GE, BWK, AMB, MYB); and the Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (MYB).
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Gijs Elshout
the Department of General Practice, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands (MK, GE, BWK, AMB, MYB); and the Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (MYB).
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Bart W. Koes
the Department of General Practice, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands (MK, GE, BWK, AMB, MYB); and the Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (MYB).
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Arthur M. Bohnen
the Department of General Practice, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands (MK, GE, BWK, AMB, MYB); and the Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (MYB).
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Marjolein Y. Berger
the Department of General Practice, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands (MK, GE, BWK, AMB, MYB); and the Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (MYB).
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Abstract

Background: It is unclear how well a C-reactive protein (CRP) value predicts a serious infection (SI) in young febrile children in general practice.

Methods: This prospective cohort study with 1-week follow-up included children, aged 3 months to 6 years, presenting with fever to a general practitioner out-of-hours service. We evaluate whether CRP level has predictive value for diagnosing a child at risk for an SI either at presentation or during follow-up. The index test was CRP ≤20 mg/L (rule out an SI) and >80 mg/L (rule in an SI). The reference standard was referral to a pediatric emergency department or diagnosis of an SI. The main outcome measure was CRP value.

Results: CRP level was available for 440 children. To rule out an SI, CRP ≤20 mg/L did not change the probability of having no SI (87.5%). CRP >80 mg/L increased the probability of having an SI from 11.4% (pretest probability) to 21.2% (posttest probability). In children without a diagnosis of SI at presentation, CRP could not predict an SI during follow-up (CRP >80 mg/L: positive likelihood ratio, 2.1, 95% confidence interval, 1.3–3.5; CRP ≤20 mg/L: negative likelihood ratio, 0.9, 95% confidence interval, 0.7–1.2).

Conclusions: In general practice CRP has little clinically relevant value in discriminating febrile children in need of medical care from those who are not.

  • C-Reactive Protein
  • Child
  • Cohort Studies
  • Hospital Emergency Service
  • Family Practice
  • Fever
  • Follow-Up Studies
  • General Practice
  • General Practitioners
  • Hospital Records
  • Humans
  • Outcome Assessment (Health Care)
  • Point-of-Care Systems
  • Probability
  • Prospective Studies
  • Referral and Consultation
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The Journal of the American Board of Family     Medicine: 29 (4)
The Journal of the American Board of Family Medicine
Vol. 29, Issue 4
July-August 2016
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C-Reactive Protein Level as Diagnostic Marker in Young Febrile Children Presenting in a General Practice Out-of-Hours Service
Marijke Kool, Gijs Elshout, Bart W. Koes, Arthur M. Bohnen, Marjolein Y. Berger
The Journal of the American Board of Family Medicine Jul 2016, 29 (4) 460-468; DOI: 10.3122/jabfm.2016.04.150315

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C-Reactive Protein Level as Diagnostic Marker in Young Febrile Children Presenting in a General Practice Out-of-Hours Service
Marijke Kool, Gijs Elshout, Bart W. Koes, Arthur M. Bohnen, Marjolein Y. Berger
The Journal of the American Board of Family Medicine Jul 2016, 29 (4) 460-468; DOI: 10.3122/jabfm.2016.04.150315
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Keywords

  • C-Reactive Protein
  • Child
  • Cohort Studies
  • Hospital Emergency Service
  • Family Practice
  • Fever
  • Follow-Up Studies
  • General Practice
  • General Practitioners
  • Hospital Records
  • Humans
  • Outcome Assessment (Health Care)
  • Point-of-Care Systems
  • Probability
  • Prospective Studies
  • Referral and Consultation

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