CRP RAPID TEST DURING THE VISIT OF FAMILY DOCTOR Madis Veskimägi ESTONIA FAMILY PHYSICIANS`CENTRE OF TÕSTAMAA 17 th World Conference of Family Doctors October 13-1717 2004 ORLANDO, FLORIDA, USA Contents of presentation Introduction Overwiew of study: Comparision CRP level and severity picture of dissease on reception and course of illness CRP in various clinical setting Arrangement of work Some clinical pearls Discussion and summary Introduction C reactive protein (CRP) is a well-known marker in the estimation of inflammatory activity of the organism, the presence of tissue lesions and simplifies to follow the This aspects make CRP as very high valuable test in primary care Average distribution of patients depending on the main problem Unclear condition 5% Monitoring course of illness 20% Unclear pain (chest, back, abdomen, extremities) 5% Skin and soft tissue infection 10% Arthropathy 10% Respiratory infection 50% Problems in everyday work The results will come after 1 hour to 1-2 days, depending on the working regimen of the medicinal institution and the methodology used The patient has to visit the different rooms or medicinal institution All this takes time, decreasing the enthusiasm both of patient and doctor Very often the more simple way of action is being chosen But that is leading to the choice of improper treatment and wrong way of action
REVIEW OF STUDY The aim of the present study was to estimate the connections between the results of CRP rapid test, performed by rural family doctor during the ambulatory or home visit and clinical statement and later METHODOLOGY The study material is from the time period of 01.01.2003-07.03.200407.03.2004 Performed 188 CRP rapid tests Comparison of the quantitative results, got by Quik-Read CRP methodology and picture of disease and difficulty of situation, determined during the visit and further RESULTS The ten-point scale has been used: 1 light...10 complicated Comparing these data the following correlative relations have been calculated The difficulty of the common statement during the visit and level of CRP. The level of CRP and difficulty of the 188 rapid tests have been performed Mean age of studied patients 36,6 y, the youngest ½ y and the oldest 94 y 79 male and 109 female patients The average CRP level 43,5 mg/l Indication of test depending on main problem Estimation of course of illnes 14% Upper resp. tract infection 20% Results grouped by CRP value and further management Unclear condition 14% CRP, mg/l 8-30 Total 111 (59%) Anti- bacterial 16 (14%) Sympto- matic 93 ( 84%) Stationary 2 (2%) Cardiovascular dissease 1% Rheumatological complain 6% Skin and soft tissue infection 4% Genitourinary tract infection 4% Lower resp. tract infection 15% Ear-nose-throat infection 15% 31-50 51-100100 101-160160 21 (11%) 22 (12%) 34 (18%) 8 (38%) 1 (5%) - 12 (57%) 19 (86%) 27 (79%) 1 (5%) 2 ( 9%) 7 (21%) Abdominal and back pain 7%
Results grouped by CRP value and further management, 111 93 16 2 21 8 12 1 22 1 19 2 34 0 27 7 Total Symptomatic Antibacterial Hospital Comparision CRP and common statement in reception The coefficient of correlation between the difficulty of the common statement, estimated during the visit and the CRP level is 0,23 The correlative relation is very weak 8..30 31..50 51-100 101-160 CRP, mg/l CRP in various clinical settings The coefficient of correlation between the CRP level, determined during the visit and the difficulty of the further is 0,79 The correlative relation is strong Speticaemia, endocarditis, osteomyelitis. In beginning of dissease the symptoms may be almost identical those of viral infection. Markedly elevated CRP > 100 mg/l usually suggest bacterial or fungal infection Meningitis. In presence of meningeal symptoms CRP helps to distinguish bacterial and viral infection ( CRP < 20 mg/l) Pneumonia and bronchitis. The presence of lower respiratory tract symptoms the CRP > 60 mg/l suggest pneumonia of bacterial origin, otherwise likely diagnosis is bronchitis Sinusitis. H.influenzae is most common cause of condition, in these cases CRP level rise to 20 mg/l. CRP > 40 mg/l suggest infection due to S.pyogenes or S.pneumonia with higher risk of empyema Bacterial pharyngitis.. CRP level 35 mg/l could be a use for distinguishing infection of bacterial origin Urinary tract infection. CRP values higher 100-140mg/l suggest pyelonephritis. In cases of lumbar pain solely, elevated CRP level suggest infectious origin Rheumatoid arthritis. CRP and ESR are valuable markers of disease severity and monitoring Myocardial infarction. CRP elevation rate correlate with infarction size, it remain 40-160 mg/l. CRP is very valuable test in cases of chest pain or dyscomfort of unknown origin. Appendicitis. In nonperforated appendicitis the CRP remain 20-40 mg/l, in perforation CRP > 100 mg/l. As above CRP is very valuable in atypical abdominal pain.
Point-of-care testing Point of care testing denotes any analytical procedure performed for or by a patient outside the traditional clinical laboratory near the patient Arrangement of work QuikRead CRP for point-of-care testing Equipment is placed in examination room Test is usually performed by doctor during primary reception and examination of patient 2-3 minutes for test Equipment is carried by doctor to homevisits especially to elderly people or children View to examination room Diagnostical orchestra CRP equipment Homevisit to 92 y. man, former miller History for 1 week of cough, light degree of dyspnoe, fever 37,2-37,637,6 C General condition well On examination light degree heart insufficienty, suspicion to pneumonia
Equipment Taking a fingertip blood Adding blood and buffer solution into ditch Adding CRP reagent and puting into analyser...and getting result DIAGNOSIS: PNEUMONIA Prescribed antibacterial treatment orally and heart supporting treatment due to light degree insifficiency Following course was good, in week later patient was able to go to reception in office Homevisit to 3 y. old girl 3 day history of fever 37,5; a light cough Rapid rise of fever, up to 40 C Alarm from mother History and examination- suspicion of pneumonia CRP 8 mg/l Symptomatic treatment Following course good, next day temperature normal
Homevisit to 2 y. girl History of fever 37,5-3838 C, dropping nose for 2 day On examination general condition quite well, lungs normal, red throat CRP 98 mg/l Diagnosis: Bacterial pharyngitis. After treatment ( Unasyn) on 2.nd diay temperature normal CRP on 6 th day 8 mg/l 45 y. Man, visit to office History of two day of pain and swollowing in right elbow General condition quite well, revealed red and odematous elbow CRP > 160 mg/l Diagnosis: Erysipelas. Sepsis? Urgent hospitalisation Et cetera, et cetera, et cetera 184 interesting cases!!! SUMMARY AND CONCLUSIONS The correlation between clinical picture and severity of dissease found during examination and CRP level is weak (0,23) Well looking patient may have severe condition and vice versa The correlation between CRP level and complicated latter course of dissease is strong ( 0,79) CRP test during reception CRP is perfect tool in ensuring a correct diagnosis and determining the need for further treatment It is crucial that result of CRP is available during minutes in reception Economical aspects: reducing unnecessary antibacterial treatment and hospitalisation CRP is valuable in monitoring the course of an illness and efficacy of antimicrobial therapy CRP in uncertain condition is valuable for detecting serious condition which need urgent consultation or hospitalisation
The CRP rapid test will increase compliance of both patient and doctor Doctor can find a right solution and patient get the right treatment One chance for controlling a body weight, general well-being and moderate hypertension Thank you for attention and welcome to Estonia