Systematic review of the diagnostic accuracy of C-Reactive protein to detect bacterial infection in nonhospitalized infants and children with fever

Sanders, Sharon, Barnett, Adrian, Correa-Velez, Ignacio, Coulthard, Mark and Doust, Jenny (2008) Systematic review of the diagnostic accuracy of C-Reactive protein to detect bacterial infection in nonhospitalized infants and children with fever. The Journal of Pediatrics, 153 4: 570-574.e3. doi:10.1016/j.jpeds.2008.04.023


Author Sanders, Sharon
Barnett, Adrian
Correa-Velez, Ignacio
Coulthard, Mark
Doust, Jenny
Title Systematic review of the diagnostic accuracy of C-Reactive protein to detect bacterial infection in nonhospitalized infants and children with fever
Journal name The Journal of Pediatrics   Check publisher's open access policy
ISSN 0022-3476
1097-6833
Publication date 2008-10-01
Year available 2008
Sub-type Article (original research)
DOI 10.1016/j.jpeds.2008.04.023
Open Access Status
Volume 153
Issue 4
Start page 570
End page 574.e3
Total pages 9
Editor William F. Balistreri
Place of publication St. Louis, U.S.
Publisher Mosby-Elsevier
Language eng
Subject C1
111403 Paediatrics
1114 Paediatrics and Reproductive Medicine
111717 Primary Health Care
Abstract Objective To determine the accuracy of C-reactive protein (CRP) for diagnosing serious bacterial and bacterial infections in infants and children presenting with fever.
Formatted abstract
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.

Keyword Respiratory tract infections
Febrile infants
Emergency department
Localizing signs
Procalcitonin
Influenza
Markers
Utility
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 44 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 09 Apr 2009, 21:18:13 EST by Amanda Jones on behalf of Faculty Of Health Sciences