Discriminative Accuracy of Procalcitonin and Traditional Biomarkers in Pediatric Acute Musculoskeletal Infection
| Autor: | Amanda J. Nickel, Jennifer C. Laine, Brianna McMichael, Eric W. Christensen, Walter H. Truong, Kristin A Frenn, Anupam B. Kharbanda |
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| Rok vydání: | 2020 |
| Předmět: |
Calcitonin
medicine.medical_specialty Blood Sedimentation Gastroenterology Procalcitonin 03 medical and health sciences 0302 clinical medicine 030225 pediatrics White blood cell Internal medicine medicine Humans Prospective Studies Child Prospective cohort study Receiver operating characteristic medicine.diagnostic_test business.industry 030208 emergency & critical care medicine General Medicine medicine.disease Confidence interval medicine.anatomical_structure Erythrocyte sedimentation rate Pediatrics Perinatology and Child Health Emergency Medicine Biomarker (medicine) Septic arthritis business Biomarkers |
| Zdroj: | Pediatric Emergency Care. 37:e1220-e1226 |
| ISSN: | 1535-1815 0749-5161 |
| Popis: | Objectives Septic arthritis (SA) is responsible for 20% of pediatric musculoskeletal infections (MSKI) and can have significant consequences. Early detection of SA is critical, and procalcitonin (PCT) has emerged as a promising biomarker. This study assessed the test performance of PCT and traditional biomarkers for suspected SA. Methods We conducted a prospective study at two pediatric emergency departments (ED). Data collected measured serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and PCT. Box and whisker plots were generated to compare the of the biomarkers by positive MSKI or a non-MSKI diagnosis. The diagnostic performance of biomarkers was examined using the area under the receiver operating characteristic curve (AUC), and optimal cut -points were identified using the Liu method. Results Procalcitonin performed reasonably well for detection of MSKI (AUC, 0.72; confidence interval [95% CI], 0.59-0.84). However, CRP and ESR performed better (AUC, 0.88 and 0.78, respectively). White blood cell count was not predictive of MSKI. Patients with a PCT value >0.1 ng/mL, ESR values >19.5 mm/h, and a temperature higher than 99.0°F were more than twice as likely to have acute MSKI. A high CRP level was most predictive of acute MSKI, and patients with levels >2.38 mg/dL were 3.5 times more likely to have acute MSKI. Conclusions Procalcitonin is a potential biomarker for the clinical differential of MSKI in the pediatric ED. Additional research is warranted to establish the optimal diagnostic level for PCT, to increase sample size, and to examine any impact on cost. |
| Databáze: | OpenAIRE |
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