Dr. Claudius: You certainly got off the funniest quip. The remark about how everybody has some relative somewhere who was paralyzed by a spinal tap. Best, John Bibb. MD, FACEP
Unfortunately many ED’s are in this situation. The article states you can use the other markers as a substitute. However, the robust data is only for the models that include the procalcitonin. Personally, I would error on the side of full work up and admission for under 28 days. Would consider if CRP, WBC and temp are normal possibly discharging a child if remainder of full septic work up including LP are normal between 28 days and 6 weeks.
As Dr. Sacchetti mentioned, the AAP guidelines recommend using height of fever (T > 38.5) as an inflammatory marker if procalcitonin is not available to you. The data and advice from these guidelines comes from a variety of sources rather than one particular study, so I don't have exact sensitivity/specificity numbers. That said, there are published protocols, such as the Roseville protocol (Nguyen THP, et al. Hosp Pediatrics 2021), that utilize temperature, WBC, and absolute band count (No procalcitonin, no CRP) that demonstrated negative predictive values of 99.5% in the 7-28 day old age group. Overall, I would recommend erring on the side of caution in the younger age group (full workup, empiric abx, admission) for those under 28 days if you don't have the ability to obtain the relevant data. On the other hand, I would feel comfortable using many of the other risk stratification strategies that are published to help determine the plan for managing the older infant (29-60 days old).
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John B. - November 3, 2021 8:12 AM
Dr. Claudius:
You certainly got off the funniest quip. The remark about how everybody has some relative somewhere who was paralyzed by a spinal tap.
Best,
John Bibb. MD, FACEP
Alfred S. - November 3, 2021 8:45 AM
Agree
ilene c. - November 3, 2021 10:20 AM
:)
It's easier to be cynical when you are out of the fray!
Mike - November 21, 2021 9:35 PM
Do you have any idea how sensitive the guideline protocols are without using procalcitonin which is unavailable at my institution? Thanks!
Alfred S. - November 22, 2021 7:10 AM
Unfortunately many ED’s are in this situation. The article states you can use the other markers as a substitute. However, the robust data is only for the models that include the procalcitonin. Personally, I would error on the side of full work up and admission for under 28 days. Would consider if CRP, WBC and temp are normal possibly discharging a child if remainder of full septic work up including LP are normal between 28 days and 6 weeks.
Jeff S. - November 22, 2021 8:48 AM
As Dr. Sacchetti mentioned, the AAP guidelines recommend using height of fever (T > 38.5) as an inflammatory marker if procalcitonin is not available to you. The data and advice from these guidelines comes from a variety of sources rather than one particular study, so I don't have exact sensitivity/specificity numbers. That said, there are published protocols, such as the Roseville protocol (Nguyen THP, et al. Hosp Pediatrics 2021), that utilize temperature, WBC, and absolute band count (No procalcitonin, no CRP) that demonstrated negative predictive values of 99.5% in the 7-28 day old age group.
Overall, I would recommend erring on the side of caution in the younger age group (full workup, empiric abx, admission) for those under 28 days if you don't have the ability to obtain the relevant data. On the other hand, I would feel comfortable using many of the other risk stratification strategies that are published to help determine the plan for managing the older infant (29-60 days old).