Out-of-hours antibiotic prescription after screening with C reactive protein: a randomised controlled study

Ingrid Keilegavlen Rebnord, Hogne Sandvik, Anders Batman Mjelle, Steinar Hunskaar, Ingrid Keilegavlen Rebnord, Hogne Sandvik, Anders Batman Mjelle, Steinar Hunskaar

Abstract

Objective: To evaluate the effect of preconsultation C reactive protein (CRP) screening on antibiotic prescribing and referral to hospital in Norwegian primary care settings with low prevalence of serious infections.

Design: Randomised controlled observational study at out-of-hours services in Norway.

Setting: Primary care.

Participants: 401 children (0-6 years) with fever and/or respiratory symptoms were recruited from 5 different out-of-hours services (including 1 paediatric emergency clinic) in 2013-2015.

Intervention: Data were collected from questionnaires and clinical examination results. Every third child was randomised to a CRP test before the consultation; for the rest, the doctor ordered a CRP test if considered necessary.

Outcome measures: Main outcome variables were prescription of antibiotics and referral to hospital.

Results: In the group pretested with CRP, the antibiotic prescription rate was 26%, compared with 22% in the control group. In the group pretested with CRP, 5% were admitted to hospital, compared with 9% in the control group. These differences were not statistically significant. The main predictors for ordering a CRP test were parents' assessment of seriousness of the illness and the child's temperature. Paediatricians ordered CRP tests less frequently than did other doctors (9% vs 56%, p<0.001).

Conclusions: Preconsultation screening with CRP of children presenting to out-of-hours services with fever and/or respiratory symptoms does not significantly affect the prescription of antibiotics or referral to hospital.

Trial registration number: NCT02496559; Results.

Keywords: C-reactive protein; PRIMARY CARE; Prescriptions; Referral and Consultation.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Flow chart over included and investigated patients in the study. CRP, C reactive protein; OOH, out-of-hours.

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