CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION - PowerPoint PPT Presentation

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CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION

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Short discussion of primary care 'pain and charm' ... Work arrangement with QuikRead ... Objective data in doubt of serious illnes in well-looking patient ... – PowerPoint PPT presentation

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Title: CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION


1
CRP RAPID TEST AS REAL SUPPORT IN CLINICAL
DECISION
QuikRead Sales Meeting12-15 June 2005
HelsinkiFINLAND
Madis Veskimägi FAMILY PHYSICIANS CENTRE OF
TÕSTAMAA, ESTONIA
2
AIM OF PRESENTATION
  • Short discussion of primary care pain and charm
  • How looks like an ideal test in context of
    primary care speciality
  • Work arrangement with QuikRead

3
  • Patients general condition in reception, CRP
    level and later course of illness. Is there any
    correlation. Overview of study.
  • Some illustrative examples of real life
  • Discussion and conclusion

4
PAIN AND CHARM OF PRIMARY CARE
  • Wide spectrum of patients and problems from
    infant to elderly
  • Need for a quick assesment of patients
    condition
  • Making proper plan for later management during
    10-15 min in reception or in patients home

5
  • Lack of time both doctor and patient
  • A lot of talk and serious complaints
  • Sometimes patients do not talk absolutely
    (infants, patients with dementia or stroke)
  • Pressure from patient for getting a useless
    prescription of antibiotics or admission to
    hospital

6
  • Lack of objective data
  • Need for assesment course of illnes and proper
    intervention
  • Danger missing of serious condition which need a
    quik admission to hospital

7
AND FINALLY AS MOST IMPORTANT....
8
NEED FOR REDUCING ANXIETY OF PATIENT AND
DOUBTFULLNESS OF DOCTOR
9
IDEAL TEST IN PRIMARY CARE
  • Accuracy
  • Quickness
  • Answer for main question
  • Severity of infection or tissue damage
  • Distinguishing viral or bacterial infection
  • Monitoring the course of illness
  • Objective data in doubt of serious illnes in
    well-looking patient

10
ONE AND IDEAL TEST ABSENT, BUT TEST WHICH IS
NEARLY PROPER OF PREVIOUS CRITERION IS C
REACTIVE PROTEIN RAPID TEST
11
WORK ARRANGEMENT WITH QuikRead CRP
  • 2-5 CRP QuikRead tests daily
  • Answer during reception
  • Equipment in examinations room with all
    diagnostical equipment of rural healthcare centre

12
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13
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14
DIAGNOSTICAL ORCHESTRA
15
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16
  • Test is usually done by doctor on the need. So we
    can save time and win patients pressure for
    getting any prescription etc.
  • QuikRead equipment is carried in homevisits when
    indicated

17
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18
PATIENTS GENERAL CONDITION IN RECEPTION. CRP
LEVEL AND LATER COURSE OF ILLNESS. OVERVIEW OF
STUDY
19
  • In primary care is common a mixture of somatic
    and light-degree of psychiatric compliants
  • In patients with serious complaints may have a
    light, self-limiting dissease

20
  • Contrarily may have a well-looking patient a
    serious condition which need an urgent
    intervention
  • Is there any correlation-it is the subject for
    following study

21
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 course of disease

22
METHODOLOGY
  • The study material is from the time period of
    01.01.2003-07.03.2004
  • 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 course of disease

23
  • 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 course of
    disease

24
RESULTS
  • 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

25
Indication of test depending on main problem
26
Results grouped by CRP value and further
management
27
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

28
  • The coefficient of correlation between the CRP
    level, determined during the visit and the
    difficulty of the further course of disease is
    0,79
  • The correlative relation is strong

29
SUMMARY OF STUDY
  • 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)

30
ILLUSTRATIVE CASES.HOW MEDICAL THOUGHT IS
CHANGED AFTER CRP RAPID TEST
31
ACUTE PHARYNGITIS
  • 13 y old girl, history for a 3 days of painful
    swallowing, weakness and temperature 38-39 C
  • The case is complicated by a exessive anxiety
    from mother and pressure for getting at least
    antibiotic or admission to hospital
  • General condition good, medium degree rednes of
    throat, local tenderness of noduli

32
INITIAL DIAGNOSIS BEFORE TESTS ACUTE
PHARYNGITIS, UNKNOWN ETIOLOGY
33
TESTS
  • Strep A neg.
  • CRP lt 8 mg

34
DIAGNOSIS AFTER TESTSVIRAL PHARYNGITIS
35
LATER COURSE OF ILLNESS
  • Prescribed painkillers and warm tea
  • In 2 days there absent fever and complaints

36
TUBERCULOSIS OF LUNGS
  • 45 y old man, history 2 days of pain in right
    side of chest, temperature 37,2 C and cough
  • General condition is good, findings of
    ausculation and percussion completely normal
  • There was a doubt of malingering. Patient has a
    history of hyposocial life. He was send from city
    to farm as unskilled worker

37
INITIAL DIAGNOSIS BEFORE CRP TESTCOMMON COLD
38
CRP 127 mg/l
39
DIAGNOSIS AFTER CRP TESTSTRONG SUSPICION OF
SERIOUS CONDITION PROBABLY PULMONARY ORIGIN.
IDEA FOR CHEST X-RAY
40
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41
NEW DIAGNOSISPNEUMONIA OR STRONG SUSPICION OF
PULMONARY TUBERCULOSIS. THERE WAS PRESCRIBED
COURSE OF ANTIBIOTIC (AMOXICILLIN-CLAVULANIC
ACID). AFTER 4 DAYS OF TREATMENT...
42
...CRP 154 mg/l
43
FINAL DIAGNOSIS BEFORE REFERRAL PULMONARY
TUBERCULOSISPATIENT WAS TREATED IN DEPARTAMENT
OF TUBERCULOSIS UNIVERSITY CLINIC FOR A 2 MONTH
44
ACUTE PYELONEPHRITIS
  • 37 y man, history of 2-3 days for pain in lumbar
    region, fever 38 C
  • Patient work as forestman, a lot of carring heavy
    trees, exposition of wet and cold
  • General condition was satisfactory, there
    revealed pain on palpation right side of lumbar
    back

45
INITIAL DIAGNOSIS BEFORE CRP TESTCOMMON COLD,
LUMBALGIA DUE TO A HEAVY LIFTING
46
CRP 117 mg/l
47
NEW WORKING DIAGNOSISACUTE PYELONEPHRITIS. IDEA
FOR DIP-STICK TEST OF URINE REVEAL OF POSITIVE
NITROGEN AND LEUCOCYTE
48
FOLLOWING COURSETHERE WAS PRESCRIBED NORFLOXACIN
0,4 x3, PROPER REGIMENIN 9 DAYS LATER THERE
ABSENT COMPLAINTS AND THE LEVEL OF CRP WAS...
49
...lt 8 mg/l
50
ACUTE MYOCARDIAL INFARCTION
  • 65 a man, history for 3 days for a unpleasant
    feeling in middle of chest, irradiating to back
    and left shoulder
  • Patient has a done physical activity, the pain
    begin in rest in theatre. Previous history absent
  • On examination general condition was good. No
    restriction of moving. Noticeable changes of
    auscultation of heart and lungs absent. BP 150/80

51
  • There reveal some tender points in back, cervical
    region
  • ECG reveal sinus rhythm, medium degree of RBBB.
    Certain findings of myocardial damage absent

52
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53
INITIAL DIAGNOSISBEFORE CRPMYOFASCIALGIA OF
CERVICAL REGION. UNCERTAIN ETIOLOGY OF RBBB
54
CRP 55 mg/l
55
NEW DIAGNOSISPROBABLY MYOCARDIAL INFARCTION IN
SHADOW OF BLOCADE
56
PATIENT WAS URGENTLY REFFERRED TO HOSPITAL. THE
BIOMARKERS OF MYOCARDIAL DAMAGE WAS ELEVATED. THE
FINAL DIAGNOSIS WAS MYOCARDIAL INFARCTION.TWO
MONTH LATER THERE WAS DONE CORONARY BYPASS
OPERATION. TODAY PATIENT LIVE IN NORMAL CONDITION
57
ACUTE GASTROENTERITIS
  • 34 y man, history for 4-5 days of diarrhoea,
    vomiting and fever 38 C
  • On examination moderately afected general
    condition, light degree of dehydration.
    Tenderness on the palpation of abdomen,
    auscultation of chest was normal
  • Family history of infection was uncertain

58
INITIAL DIAGNOSISBEFORE CRPACUTE
GASTROENTERITIS.INITIAL PLAN FOLLOW UP,
REHYDRATING SOLUTION ORALLY
59
CRP gt 160 mg/l
60
FINAL DIAGNOSISACUTE GASTROENTERITIS OF
BACTERIAL ORIGIN.PATIENT WAS URGENTLY REFFERED
TO DEPARTMENT OF INFECTIOUS DISEASES.IN HOSPITAL
THE CRP WAS 256 mg/l. CULTURAL EXAMINATION OF
COMMON ETIOLOGY WAS NEGATIVE
61
PATIENT GET AN ANTIBACTERIAL THERAPY (NORFLOXACIN
400 mg x2)i/v REHYDRATING SOLUTIONCRP LEVEL AT
THE END OF HOSPITAL THERAPY WAS 28 mg/l.
62
PHLEGMONE OF ARM
  • 46 y old man
  • History of two day of pain and swollowing in
    right elbow
  • General condition quite well, revealed red and
    odematous elbow

63
INITIAL DIAGNOSISSUPERFICIAL DERMAL INFECTION,
ERYSIPELAS ? INITIAL PLAN ORAL ANTIBACTERIAL
THERAPY, FOLLOW-UP
64
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65
CRP ? 160 mg/l
66
NEW DIAGNOSISERYSIPELAS? PHLEGMONE?SEVERE
BACTERIAL INFECTION? SEPSIS ? PATIENT WAS
URGENTLY REFFERRED TO DEPARTMENT OF SURGERY. IN
HOSPITAL THERE WAS DONE INCISIONS WOR LAVAGE,
LATER COURSE WAS GOOD
67
Et cetera, et cetera, et cetera! FOR HUNDREDS
OF INTERESTINC CASES
68
CONCLUSION AND DISCUSSION
  • 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

69
  • 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

70
  • The CRP rapid test will increase compliance of
    both patient and doctor
  • Doctor can find a right solution and patient get
    the right treatment

71
THANK YOU FOR ATTENTION !!!
72
AND WELCOME TO ESTONIA
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