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Time from fever onset and diagnostic accuracy of C-reactive protein
C-reactive protein (CRP) is widely used in the assessment of children with suspected bacterial infection although it is well known that the CRP obtained in the first 12 hours is of limited diagnostic value, at least for ruling out significant sepsis. Segal and colleagues report a prospective observational study of febrile children presenting to the emergency department (n= 373, of whom 103 had bacterial infection) looking at the diagnostic performance of CRP at different time points from fever onset. There is a considerable amount of data in the paper which is well worth working through. The optimal cut off of CRP suggesting bacterial infection increased with time from fever onset – 6mg/dl at >12 hours, 10.7 mg/dl at >24-48 hours, 12.6 mg/dl at >48 hours. Duration of fever mostly impacted on the ability of CRP to correctly rule out bacterial infection. In this cohort a CRP of 2mg/dl at <24 hours corresponded to a post test probability of bacterial infection of 10% whereas the same value at >24 hours reduced the risk to 2%. In essence the study reinforces the need to take into account the time from onset of fever when interpreting CRP and is a useful reminder that a low CRP taken …
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