CRP point of care testing
based on trial published BMJ
and (3) the evidence from systematic reviews and other studies suggests little, if any, benefit is achieved from the prescription of antibiotics, except in elderly patients at high risk of pneumonia.
2005 – said CRP not good enough test – not accurate enough http://www.bmj.com/content/331/7507/26
2009 cluster RCT in Netherlands
usual care / CRP testing / enhanced comm skills / enhanced comm skills+ crp testing
most effective to reduce was actually comm skills testing followed by CRP
CRP concentrations were <20, 20-30, 30-50, 50-100, and >100 mg/L in 74%, 8%, 9%, 6%, and 3% of patients, respectively. The proportion with pneumonia in these groups was 3%, 5%, 7%, 15%, and 35% respectively. Positive predictive values of CRP as a univariate (stand-alone) test were 11.8%, 14.8%, 22.5%, and 35.4% for concentrations over 20, 30, 50, and 100 mg/L, respectively. Negative predictive values were 97.4%, 97.2%, 96.8%, and 96.1%. Some 54 patients (3%) with radiographic pneumonia had a CRP concentration <20 mg/L.
cochrane reivew 2014
Used as an adjunct to a doctor’s clinical examination this reduction in antibiotic use did not affect patient-reported outcomes, including recovery from and duration of illness.However, a possible increase in hospitalisations is of concern. A more precise effect estimate is needed to assess the costs of the intervention and compare the use of a point-of-care biomarker to other antibiotic-saving strategies.
OMG – this does NOT prove CRP is useful as PoC…