C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm

Ralph Gonzales, Eva M. Aagaard, Carlos A. Camargo, Oscar Ma, Mark Plautz, Judith H. Maselli, Charles E. McCulloch, Sara K. Levin, Joshua P. Metlay

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Antibiotics are commonly overused in adults seeking emergency department (ED) care for acute cough illness. Objective: To evaluate the effect of a point-of-care C-reactive protein (CRP) blood test on antibiotic treatment of acute cough illness in adults. Methods: A randomized controlled trial was conducted in a single urban ED in the United States. The participants were adults (age <18 years) seeking care for acute cough illness (≤ 21 days duration); 139 participants were enrolled, and 131 completed the ED visit. Between November 2005 and March 2006, study participants had attached to their medical charts a clinical algorithm with recommendations for chest X-ray study or antibiotic treatment. For CRP-tested patients, recommendations were based on the same algorithm plus the CRP level. Results: There was no difference in antibiotic use between CRP-tested and control participants (37% [95% confidence interval (CI) 2945%] vs. 31% [95% CI 2339%], respectively; p = 0.46) or chest X-ray use (52% [95% CI 4361%] vs. 48% [95% CI 3957%], respectively; p = 0.67). Among CRP-tested participants, those with normal CRP levels received antibiotics much less frequently than those with indeterminate CRP levels (20% [95% CI 733%] vs. 50% [95% CI 3268%], respectively; p = 0.01). Conclusions: Point-of-care CRP testing does not seem to provide any additional value beyond a point-of-care clinical decision support for reducing antibiotic use in adults with acute cough illness.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Emergency Medicine
Volume41
Issue number1
DOIs
StatePublished - Jul 2011

Fingerprint

Cough
C-Reactive Protein
Anti-Bacterial Agents
Point-of-Care Systems
Confidence Intervals
Hospital Emergency Service
Thorax
Clinical Decision Support Systems
X-Rays
Sick Leave
Hematologic Tests
Emergency Medical Services
Randomized Controlled Trials
Therapeutics

Keywords

  • acute respiratory tract infections
  • antimicrobial agents
  • C-reactive protein
  • quality improvement

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. / Gonzales, Ralph; Aagaard, Eva M.; Camargo, Carlos A.; Ma, Oscar; Plautz, Mark; Maselli, Judith H.; McCulloch, Charles E.; Levin, Sara K.; Metlay, Joshua P.

In: Journal of Emergency Medicine, Vol. 41, No. 1, 07.2011, p. 1-7.

Research output: Contribution to journalArticle

Gonzales, R, Aagaard, EM, Camargo, CA, Ma, O, Plautz, M, Maselli, JH, McCulloch, CE, Levin, SK & Metlay, JP 2011, 'C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm', Journal of Emergency Medicine, vol. 41, no. 1, pp. 1-7. https://doi.org/10.1016/j.jemermed.2008.06.021
Gonzales, Ralph ; Aagaard, Eva M. ; Camargo, Carlos A. ; Ma, Oscar ; Plautz, Mark ; Maselli, Judith H. ; McCulloch, Charles E. ; Levin, Sara K. ; Metlay, Joshua P. / C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. In: Journal of Emergency Medicine. 2011 ; Vol. 41, No. 1. pp. 1-7.
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abstract = "Background: Antibiotics are commonly overused in adults seeking emergency department (ED) care for acute cough illness. Objective: To evaluate the effect of a point-of-care C-reactive protein (CRP) blood test on antibiotic treatment of acute cough illness in adults. Methods: A randomized controlled trial was conducted in a single urban ED in the United States. The participants were adults (age <18 years) seeking care for acute cough illness (≤ 21 days duration); 139 participants were enrolled, and 131 completed the ED visit. Between November 2005 and March 2006, study participants had attached to their medical charts a clinical algorithm with recommendations for chest X-ray study or antibiotic treatment. For CRP-tested patients, recommendations were based on the same algorithm plus the CRP level. Results: There was no difference in antibiotic use between CRP-tested and control participants (37{\%} [95{\%} confidence interval (CI) 2945{\%}] vs. 31{\%} [95{\%} CI 2339{\%}], respectively; p = 0.46) or chest X-ray use (52{\%} [95{\%} CI 4361{\%}] vs. 48{\%} [95{\%} CI 3957{\%}], respectively; p = 0.67). Among CRP-tested participants, those with normal CRP levels received antibiotics much less frequently than those with indeterminate CRP levels (20{\%} [95{\%} CI 733{\%}] vs. 50{\%} [95{\%} CI 3268{\%}], respectively; p = 0.01). Conclusions: Point-of-care CRP testing does not seem to provide any additional value beyond a point-of-care clinical decision support for reducing antibiotic use in adults with acute cough illness.",
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AU - Maselli, Judith H.

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AU - Levin, Sara K.

AU - Metlay, Joshua P.

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N2 - Background: Antibiotics are commonly overused in adults seeking emergency department (ED) care for acute cough illness. Objective: To evaluate the effect of a point-of-care C-reactive protein (CRP) blood test on antibiotic treatment of acute cough illness in adults. Methods: A randomized controlled trial was conducted in a single urban ED in the United States. The participants were adults (age <18 years) seeking care for acute cough illness (≤ 21 days duration); 139 participants were enrolled, and 131 completed the ED visit. Between November 2005 and March 2006, study participants had attached to their medical charts a clinical algorithm with recommendations for chest X-ray study or antibiotic treatment. For CRP-tested patients, recommendations were based on the same algorithm plus the CRP level. Results: There was no difference in antibiotic use between CRP-tested and control participants (37% [95% confidence interval (CI) 2945%] vs. 31% [95% CI 2339%], respectively; p = 0.46) or chest X-ray use (52% [95% CI 4361%] vs. 48% [95% CI 3957%], respectively; p = 0.67). Among CRP-tested participants, those with normal CRP levels received antibiotics much less frequently than those with indeterminate CRP levels (20% [95% CI 733%] vs. 50% [95% CI 3268%], respectively; p = 0.01). Conclusions: Point-of-care CRP testing does not seem to provide any additional value beyond a point-of-care clinical decision support for reducing antibiotic use in adults with acute cough illness.

AB - Background: Antibiotics are commonly overused in adults seeking emergency department (ED) care for acute cough illness. Objective: To evaluate the effect of a point-of-care C-reactive protein (CRP) blood test on antibiotic treatment of acute cough illness in adults. Methods: A randomized controlled trial was conducted in a single urban ED in the United States. The participants were adults (age <18 years) seeking care for acute cough illness (≤ 21 days duration); 139 participants were enrolled, and 131 completed the ED visit. Between November 2005 and March 2006, study participants had attached to their medical charts a clinical algorithm with recommendations for chest X-ray study or antibiotic treatment. For CRP-tested patients, recommendations were based on the same algorithm plus the CRP level. Results: There was no difference in antibiotic use between CRP-tested and control participants (37% [95% confidence interval (CI) 2945%] vs. 31% [95% CI 2339%], respectively; p = 0.46) or chest X-ray use (52% [95% CI 4361%] vs. 48% [95% CI 3957%], respectively; p = 0.67). Among CRP-tested participants, those with normal CRP levels received antibiotics much less frequently than those with indeterminate CRP levels (20% [95% CI 733%] vs. 50% [95% CI 3268%], respectively; p = 0.01). Conclusions: Point-of-care CRP testing does not seem to provide any additional value beyond a point-of-care clinical decision support for reducing antibiotic use in adults with acute cough illness.

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