C-Reactive Protein Bedside Testing in Febrile Children Lowers Length of Stay at the Emergency Department

Background C-Reactive protein (CRP) is an important diagnostic marker for serious bacterial infections in febrile children. C-Reactive protein bedside testing could potentially accelerate the diagnostic evaluation and shorten length of stay (LOS). Objective The aim of the study was to study the effect of introducing CRP bedside testing on the LOS of febrile children at the emergency department (ED). Design and Intervention A prospective observational study with a preimplementation cohort (2008) with traditional CRP testing and a postimplementation cohort (2009-2011) in which CRP bedside testing was introduced. Patients and Setting All previously healthy children with fever, aged 1 month to 16 years, attending the ED of a university hospital were included; non-ill-appearing children with an upper airway infection were not eligible for CRP bedside testing. Analysis and Main Outcome Measure Multivariable linear regression and propensity score analyses were used to determine the effect of CRP bedside testing on the logarithmic transformation length of stay [(log)LOS]. Results The preimplementation cohort included 609 children of whom 286 (47%) had traditional CRP. The postimplementation cohort included the following 1330 children: 728 (55%) children had bedside CRP and 156 (12%) children had traditional CRP. Bedside CRP significantly lowered the median LOS of children in whom an additional diagnostic CRP test was performed, from 178 minutes (interquartile range, 135-232 minutes) to 148 minutes (interquartile range, 108-200 minutes) (30 minutes, 19% of total LOS). A significant reduction of 15% of the (log)LOS remained after adjusting for other determinants of (log)LOS; propensity score analysis showed a 16% reduction. Conclusions C-Reactive protein bedside testing substantially lowered the LOS of children with fever at the ED in whom an additional diagnostic CRP test was performed.

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