title: C-Reactive Protein Bedside Testing in Febrile Children Lowers Length of Stay at the Emergency Department.
abstract: 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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  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.
authors.affiliation: From the *Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital; †Center of Medical Decision Making, Erasmus MC; and ‡Department of Clinical Chemistry, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Ruud G
authors.initials: RG
authors.lastname: Nijman
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.forename: Yolanda B
authors.initials: YB
authors.lastname: de Rijke
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000097:blood / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D016014:Linear Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D000067716:Point-of-Care Testing; D011446:Prospective Studies
chemical_list: D002097:C-Reactive Protein