Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Overprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid.

Aim

To assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI.

Design & setting

An open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services.

Method

Children between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations.

Results

There was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L.

Conclusion

It is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended.

Related collections

Most cited references 33

Record: found
Abstract: found
Article: not found

Randomization and allocation concealment: a practical guide for researchers.

Fiona Simpson, Gordon S Doig (2005)

Although the randomized controlled trial is the most important tool currently available to objectively assess the impact of new treatments, the act of randomization itself is often poorly conducted and incompletely reported. The primary purpose of randomizing patients into treatment arms is to prevent researchers, clinicians, and patients from predicting, and thus influencing, which patients will receive which treatments. This important source of bias can be eliminated by concealing the upcoming allocation sequence from researchers and participants. Although there are many approaches to randomization that are known to effectively conceal the randomization sequence, the use of sequentially numbered, opaque sealed envelopes (SNOSE) is both cheap and effective. The purpose of this tutorial is to describe a step-by-step process for the preparation of SNOSE. We will outline how to prepare SNOSE to preserve allocation concealment in a trial that (a) uses unrestricted (simple) randomization, (b) stratifies randomization on one factor, (c) uses permuted blocks and, and (d) is conducted at more than 1 study site.

0 comments Cited 164 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial

Jochen W. L. Cals, Christopher Butler, Rogier Hopstaken … (2009)

Objective To assess the effect of general practitioner testing for C reactive protein (disease approach) and receiving training in enhanced communication skills (illness approach) on antibiotic prescribing for lower respiratory tract infection. Design Pragmatic, 2×2 factorial, cluster randomised controlled trial. Setting 20 general practices in the Netherlands. Participants 40 general practitioners from 20 practices recruited 431 patients with lower respiratory tract infection. Main outcome measures The primary outcome was antibiotic prescribing at the index consultation. Secondary outcomes were antibiotic prescribing during 28 days’ follow-up, reconsultation, clinical recovery, and patients’ satisfaction and enablement. Interventions General practitioners’ use of C reactive protein point of care testing and training in enhanced communication skills separately and combined, and usual care. Results General practitioners in the C reactive protein test group prescribed antibiotics to 31% of patients compared with 53% in the no test group (P=0.02). General practitioners trained in enhanced communication skills prescribed antibiotics to 27% of patients compared with 54% in the no training group (P<0.01). Both interventions showed a statistically significant effect on antibiotic prescribing at any point during the 28 days’ follow-up. Clinicians in the combined intervention group prescribed antibiotics to 23% of patients (interaction term was non-significant). Patients’ recovery and satisfaction were similar in all study groups. Conclusion Both general practitioners’ use of point of care testing for C reactive protein and training in enhanced communication skills significantly reduced antibiotic prescribing for lower respiratory tract infection without compromising patients’ recovery and satisfaction with care. A combination of the illness and disease focused approaches may be necessary to achieve the greatest reduction in antibiotic prescribing for this common condition in primary care. Trial registration Current Controlled Trials ISRCTN85154857.

0 comments Cited 148 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Viral bronchiolitis

Todd Florin, Amy Plint, Joseph Zorc (2016)

Summary Viral bronchiolitis is a common clinical syndrome affecting infants and young children. Concern about its associated morbidity and cost has led to a large body of research that has been summarised in systematic reviews and integrated into clinical practice guidelines in several countries. The evidence and guideline recommendations consistently support a clinical diagnosis with the limited role for diagnostic testing for children presenting with the typical clinical syndrome of viral upper respiratory infection progressing to the lower respiratory tract. Management is largely supportive, focusing on maintaining oxygenation and hydration of the patient. Evidence suggests no benefit from bronchodilator or corticosteroid use in infants with a first episode of bronchiolitis. Evidence for other treatments such as hypertonic saline is evolving but not clearly defined yet. For infants with severe disease, the insufficient available data suggest a role for high-flow nasal cannula and continuous positive airway pressure use in a monitored setting to prevent respiratory failure.

0 comments Cited 132 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BJGP Open

Journal ID (iso-abbrev): BJGP Open

Journal ID (publisher-id): bjgpoa

Journal ID (hwp): bjgpoa

Title: BJGP Open

Publisher: Royal College of General Practitioners (London )

ISSN (Electronic): 2398-3795

Publication date (Electronic): 11 July 2018

Publication date Collection: October 2018

Publication date PMC-release: 11 July 2018

Volume: 2

Issue: 3

Electronic Location Identifier: bjgpopen18X101600

Affiliations

[1 ]deptGP and PhD Student, Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht, Netherlands

[2 ]deptGP and Associate Professor, Department of Primary Care Health Sciences , University of Oxford , Oxford, UK

[3 ]deptGP , General Practice de Bongerd , Borculo, Netherlands

[4 ]deptGP and Professor of Primary Care, Department of Family Medicine , CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, Netherlands

[5 ]deptPhD Student, Julius Center for Health Sciences and Primary Care , University Medical Center , Utrecht, Netherlands

[6 ]deptGP and Innovation Specialist , Star-SHL , Etten-Leur, Netherlands

[7 ]deptManager of Innovation , Saltro Diagnostic Center for Primary Care , Utrecht, Netherlands

[8 ]deptGP and Professor of Primary Care, Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht, Netherlands

[9 ]deptGP and Professor of Primary Care, Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht, Netherlands

Author notes

*For correspondence: m.j.c.schot-3@ 123456umcutrecht.nl

Article

Publisher ID: 01600

DOI: 10.3399/bjgpopen18X101600

PMC ID: 6189779

PubMed ID: 30564733

SO-VID: 91118dbd-8d79-4426-b12f-0d1a20fc71ac

License:

This article is Open Access: CC BY 4.0 license ( https://creativecommons.org/licenses/by/4.0/)

Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial

Read this article at

Abstract

Background

Aim

Design & setting

Method

Results

Conclusion

Related collections

Chinese Journal of General Practice

Most cited references 33

Randomization and allocation concealment: a practical guide for researchers.

Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial

Viral bronchiolitis

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 66

Cited by 9

Most referenced authors 372