Verbakel JY, et al. - Authors attempted to develop improved tools with the intention of analyzing children attending ambulatory hospital care, integrating clinical features with point-of-care C reactive protein (CRP) in Belgium. Stratification of children could be done into 3 risk groups through a CRP test, guiding assessment of clinical features that could be performed by junior doctors or nurses. It was determined that the algorithm could exclude serious infection in one-third of acutely ill children.

Methods

• The scheme of this research was a prospective observational diagnostic study.
• Eligible candidates included 5,517 acutely ill children (1 month-16 years) presenting to 106 paediatricians at 6 outpatient clinics and 6 Emergency Departments in Belgium.
• Index test included point-of-care CRP alongside vital signs and objective symptoms measurements.
• Hospital admission for >24 hours with a serious infection <5 days after presentation served as the main outcome.

Results

• During this study, an algorithm was developed consisting of clinical features and CRP.
• A 97.1% (95% CI 94.3% to 98.7%) sensitivity and 99.6% (95% CI 99.2% to 99.8%) negative predictive value was achieved through this, excluding serious infections in 36.4% of children.
• Additionally, it stratified patients into 3 groups based on CRP level: High-risk group with CRP >75 mg/L (26.8% risk of infection), intermediate-risk group with CRP 20–75 mg/L and at least one of seven clinical features (8.1%), and lower risk group with CRP <20 mg/L with at least one of the 11 features (3.8%).
• Data demonstrated that children in intermediate-risk or low-risk groups with normal clinical assessment presented with 0.6% and 0.4% risk of serious infections, respectively.