Title: CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION
1CRP RAPID TEST AS REAL SUPPORT IN CLINICAL
DECISION
QuikRead Sales Meeting12-15 June 2005
HelsinkiFINLAND
Madis Veskimägi FAMILY PHYSICIANS CENTRE OF
TÕSTAMAA, ESTONIA
2AIM 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
4PAIN 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
7AND FINALLY AS MOST IMPORTANT....
8NEED FOR REDUCING ANXIETY OF PATIENT AND
DOUBTFULLNESS OF DOCTOR
9IDEAL 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
10ONE AND IDEAL TEST ABSENT, BUT TEST WHICH IS
NEARLY PROPER OF PREVIOUS CRITERION IS C
REACTIVE PROTEIN RAPID TEST
11WORK 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(No Transcript)
13(No Transcript)
14DIAGNOSTICAL ORCHESTRA
15(No Transcript)
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(No Transcript)
18PATIENTS 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
21REVIEW 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
22METHODOLOGY
- 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
24RESULTS
- 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
25Indication of test depending on main problem
26Results grouped by CRP value and further
management
27Comparision 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
29SUMMARY 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)
30ILLUSTRATIVE CASES.HOW MEDICAL THOUGHT IS
CHANGED AFTER CRP RAPID TEST
31ACUTE 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
32INITIAL DIAGNOSIS BEFORE TESTS ACUTE
PHARYNGITIS, UNKNOWN ETIOLOGY
33TESTS
34DIAGNOSIS AFTER TESTSVIRAL PHARYNGITIS
35LATER COURSE OF ILLNESS
- Prescribed painkillers and warm tea
- In 2 days there absent fever and complaints
36TUBERCULOSIS 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
37INITIAL DIAGNOSIS BEFORE CRP TESTCOMMON COLD
38CRP 127 mg/l
39DIAGNOSIS AFTER CRP TESTSTRONG SUSPICION OF
SERIOUS CONDITION PROBABLY PULMONARY ORIGIN.
IDEA FOR CHEST X-RAY
40(No Transcript)
41NEW 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
43FINAL DIAGNOSIS BEFORE REFERRAL PULMONARY
TUBERCULOSISPATIENT WAS TREATED IN DEPARTAMENT
OF TUBERCULOSIS UNIVERSITY CLINIC FOR A 2 MONTH
44ACUTE 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
45INITIAL DIAGNOSIS BEFORE CRP TESTCOMMON COLD,
LUMBALGIA DUE TO A HEAVY LIFTING
46CRP 117 mg/l
47NEW WORKING DIAGNOSISACUTE PYELONEPHRITIS. IDEA
FOR DIP-STICK TEST OF URINE REVEAL OF POSITIVE
NITROGEN AND LEUCOCYTE
48FOLLOWING 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
50ACUTE 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(No Transcript)
53INITIAL DIAGNOSISBEFORE CRPMYOFASCIALGIA OF
CERVICAL REGION. UNCERTAIN ETIOLOGY OF RBBB
54CRP 55 mg/l
55NEW DIAGNOSISPROBABLY MYOCARDIAL INFARCTION IN
SHADOW OF BLOCADE
56PATIENT 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
57ACUTE 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
58INITIAL DIAGNOSISBEFORE CRPACUTE
GASTROENTERITIS.INITIAL PLAN FOLLOW UP,
REHYDRATING SOLUTION ORALLY
59CRP gt 160 mg/l
60FINAL 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
61PATIENT GET AN ANTIBACTERIAL THERAPY (NORFLOXACIN
400 mg x2)i/v REHYDRATING SOLUTIONCRP LEVEL AT
THE END OF HOSPITAL THERAPY WAS 28 mg/l.
62PHLEGMONE 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
63INITIAL DIAGNOSISSUPERFICIAL DERMAL INFECTION,
ERYSIPELAS ? INITIAL PLAN ORAL ANTIBACTERIAL
THERAPY, FOLLOW-UP
64(No Transcript)
65CRP ? 160 mg/l
66NEW 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
67Et cetera, et cetera, et cetera! FOR HUNDREDS
OF INTERESTINC CASES
68CONCLUSION 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
71THANK YOU FOR ATTENTION !!!
72AND WELCOME TO ESTONIA