title: C-reactive protein point-of-care testing in acutely ill children: a mixed methods study in primary care.
abstract: BACKGROUND
  Point-of-care C-reactive protein (CRP) testing of adults with acute respiratory infection in primary care reduces antibiotic prescribing by 22%. The acceptability and impact of CRP testing in children is unknown
  
  
  OBJECTIVE
  To determine the acceptability and impact of CRP testing in acutely ill children.
  
  
  METHODS
  Mixed methods study comprising an observational cohort with a nested randomised controlled trial and embedded qualitative study.
  
  
  METHODS
  Children presenting with an acute illness to general practice out-of-hours services; children with a temperature ≥38°C were randomised in the nested trial; parents and clinical staff were invited to the qualitative study.
  
  
  RESULTS
  Informed consent rates; parental and staff views on testing.
  
  
  RESULTS
  Consent to involvement in the study was obtained for 200/297 children (67.3%, 95% CI 61.7% to 72.6%); the finger-prick test might have been a contributory factor for 63 of the 97 children declining participation but it was cited as a definite factor in only 10 cases. None of the parents or staff raised concerns about the acceptability of testing, describing the pain caused as minor and transient. General practitioner views on the utility of the CRP test were inconsistent.
  
  
  CONCLUSIONS
  CRP point-of-care testing in children is feasible in primary care and is likely to be acceptable. However, it will not reduce antibiotic prescribing and hospital referrals until general practitioners accept its diagnostic value in children.
  
  
  BACKGROUND
  ISRCTN 69736109.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Van den Bruel
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Jones
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK Department of Family Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Thompson
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Mant
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007258:Informed Consent; D008297:Male; D010290:Parents; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D000067716:Point-of-Care Testing; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D036301:Qualitative Research
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: General Paediatrics; Health Service; Infectious Diseases; Outcomes research; Technology