Elsevier

The Journal of Pediatrics

Volume 153, Issue 4, October 2008, Pages 570-574.e3
The Journal of Pediatrics

Original article
Systematic Review of the Diagnostic Accuracy of C-Reactive Protein to Detect Bacterial Infection in Nonhospitalized Infants and Children with Fever

https://doi.org/10.1016/j.jpeds.2008.04.023Get rights and content

Objective

To determine the accuracy of C-reactive protein (CRP) for diagnosing serious bacterial and bacterial infections in infants and children presenting with fever.

Study design

Systematic review of diagnostic accuracy studies. We included studies comparing the diagnostic accuracy of CRP with microbiologic confirmation of (a) serious bacterial and (b) bacterial infection.

Results

For differentiating between serious bacterial infection and benign or nonbacterial infection (6 studies), the pooled estimate of sensitivity was 0.77 (95% CI, 0.68, 0.83); specificity, 0.79 (95% CI, 0.74, 0.83); positive likelihood ratio, 3.64 (95% CI, 2.99, 4.43); and negative likelihood ratio, 0.29 (95% CI, 0.22, 0.40). In multivariate analysis, CRP is an independent predictor of serious bacterial infection. 3 studies investigating the accuracy of CRP for diagnosing bacterial infection could not be pooled, but all showed a lower sensitivity compared with studies using serious bacterial infection as the reference diagnosis.

Conclusions

CRP provides moderate and independent information for both ruling in and ruling out serious bacterial infection in children with fever at first presentation. Poor sensitivity means that CRP cannot be used to exclude all bacterial infection.

Section snippets

Methods

Because clinical assessment and prior diagnostic testing may change the spectrum of patients being assessed and therefore the diagnostic accuracy of a test,8 we limited this review to studies conducted in children who came to medical attention initially with complaint of fever. Studies that included children who had been admitted to hospital (other than in an emergency department observational ward) were excluded from the review.

We included studies that compared a blood or serum CRP measurement

Study Characteristics

The search retrieved 1770 potentially relevant titles and abstracts. Of these, 10 studies assessing a total of 2046 participants met the inclusion criteria for the review. All of the studies were conducted in emergency departments. 36 studies examining the diagnostic accuracy of CRP in children admitted to hospital were excluded. Characteristics of the studies investigating CRP for the identification of serious bacterial infection and for the differentiation of bacterial and nonbacterial/viral

Discussion

We conducted a systematic review of studies assessing the diagnostic accuracy of CRP for the diagnosis of bacterial infections in children initially evaluated because of fever. The results indicate that CRP is of moderate value for ruling out serious bacterial infection in a child with a fever but is of limited value for ruling out all bacterial infections. The diagnostic accuracy of the test for all bacterial infections is limited by the significant overlap in CRP values for children with

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    Supported by a University of Queensland New Staff Start-up Grant. The funding source had no involvement in the conduct of this study.

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