Is C-reactive protein the Holy Grail for assessing febrile children?

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With this systematic review, Sanders et al provide a real service to clinicians who attempt to judge the applicability of individual C-reactive protein (CRP) studies in predicting bacterial infection in children evaluated because of fever. The authors performed a comprehensive search of relevant studies, followed explicit guidelines for assessing these reports, and methodically analyzed and reported results. The study is confined to children who were evaluated in Emergency Departments but were not hospitalized. Although CRP adds independent information to the existing tools used to distinguish children with fever who do and do not have bacterial infection, CRP is insufficiently specific to drive management and insufficiently sensitive to exclude bacterial infection—not the Holy Grail.

The expected rapid fall in CRP during adequate therapy of bacterial infection, such as osteomyelitis or pneumonia, however, is a valuable tool for clinicians in this era of antibiotic-resistant pathogens and frequently empiric therapy without bacteriologic confirmation.