Background and Aims C-Reactive Protein (CRP) is an important diagnostic marker in the evaluation of febrile children. Aim is to study if bedside CRP testing reduces the length of stay (LOS) of febrile children at the emergency department (ED).
Methods We conducted a before-after study of previously healthy children with fever, aged 1 month to 16 years, who attended the paediatric ED of the Erasmus MC - Sophia, Rotterdam, The Netherlands, between 2008–2011. Bedside CRP testing was implemented in 2009, while conventional CRP testing remained optional. We used multivariable linear regression analysis to study the effect of introducing bedside CRP testing on (log transformed) LOS at the ED.
Results In the pre-implementation cohort we included 651 children; 319 (49%) had a conventional CRP ordered at the discretion of the physician. In the post-implementation cohort we included 1376 children; 703 (51%) had bedside CRP and 223 (16%) conventional CRP testing. Bedside CRP reduced the median LOS to 148 minutes (interquartile range (IQR): 109–201); in the pre-implementation cohort this was 176 minutes (IQR: 132–231) (p<0.001). LOS of children with conventional CRP was similar between the two cohorts. Other important determinants of (log)LOS were hospitalisation (beta: 0.32 (se: 0.04), p<0.001), transfer to a different hospital (0.53 (0.04), p<0.001) and shift of presentation (daytime: 0.25 (0.03), p<0.001; evening: 0.19 (0.03), p<0.001); night = reference).
Conclusion CRP bedside testing substantially reduces LOS at the ED for children with fever. Other important determinants of LOS were hospitalisation and time of presentation.
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