Researchers from Belgium and Oxford have developed a method that involves a simple decision rule and a finger prick to test blood, enabling GPs to reduce the number of ill children being referred to hospital substantially. The test should ideally only be used on children identified as ‘at risk’ of a serious infection.
Dr Jan Verbakel, an Honorary Clinical Lecturer in Oxford University’s Nuffield Department of Primary Care Health Sciences and leader of the study, feels the findings are important to improve the accuracy of diagnosis of unwell children in primary care. This could ultimately reduce the strain on secondary health care services as the number of unnecessary hospital referrals should decline.
Serious infections such as pneumonia, meningitis, bone or kidney infections, or dangerous inflammations of the skin, have symptoms that resemble those of common viral infections in the early stages. These serious infections are also very rare. Due to the similarity in symptoms, general practitioners generally diagnose serious infections far too late. Dr Verbakel, who is also a Belgium based GP and a postdoctoral researcher at KU Leuven Faculty of Medicine where the clinical study was carried out, asked himself how fast diagnostic tests might help solve this problem.
Testing for the inflammatory marker C-reactive protein (CRP), the rapid point of care blood test takes only four minutes. In nearly 40% of children who presented as being at risk by the usual clinical assessment, serious infection was ruled out in the study. Children are deemed to be at risk when they present at least one of the following symptoms: a temperature of 40°C and above, breathlessness, or diarrhea if the child is aged between 12 and 30 months.
Seventy-eight general practices were involved in a randomized trial testing 3,100 unwell children across Flanders in Belgium. The usual clinical assessment would have flagged 57 children for referral to hospital, out of which only one would be found to have a serious infection. The researchers showed that by including the CRP test in these cases, the number of referrals could be reduced to 35.
Dr Verbakel cautions that general practitioners can’t be replaced by point of care CRP testing. The GP can sense that something is off, such as a child running a fever of more than 40°C, or being short of breath. If any of these symptoms present themselves, it’s useful to perform a point of care CRP test. The study demonstrated that all serious infections were detected during the first visit to the general practitioner with this procedure. There is however no need to test all ill children.
GPs can use a combination of a clinical examination of the patient and, when required, a point of care CRP test to detect serious infections more quickly and objectively. The procedure prevents unnecessary hospital referrals and anxiety for children who are not seriously ill. The point of care CRP test, when used responsibly, is a valuable tool for general practitioners.
The full research is published in BMC Medicine.