A retrospective analysis of the use of C-reactive protein assays in the management of acute medical admissions.
OBJECTIVE
In this study, we analysed the frequency of C-reactive protein (CRP) use in the management of acute medical admissions, the clinical reasoning behind it, and its contribution (if any) to clinical management. Our aim was to gauge the current clinical criteria used for the ordering of CRP.


METHODS
We performed a retrospective analysis of a representative sample of 171 patients who had C-reactive protein assays ordered. We compiled criteria whereby each order could be deemed either clinically indicated or inappropriate.


RESULTS
In these patients, 264 orders for CRP were made. Of these 133 (50.38%) were deemed inappropriate to the clinical scenario. The reasons for the order being inappropriate were: clinically obvious infections where the result made no difference to treatment choice (47.37%); serial measurements in patients who were clinically improving (33.58%); and CRP measurements in patients presenting with symptoms unlikely due to an infective or inflammatory processes (19.55%).


CONCLUSIONS
50.38% of C-reactive protein assays ordered in this study were clinically unnecessary, representing not only poor clinical judgement but also poor use of laboratory time and expenditure.
Kelly
Andrew P
AP
Department of General Medicine, PO Box 4345, Christchurch Hospital, Christchurch, New Zealand. andrewpkelly@hotmail.com
Murphy
Aoife M
AM
Hughes
Ruth
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019564:Unnecessary Procedures; D055815:Young Adult
D002097:C-Reactive Protein