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Abstract
Objectives Out-of-hours outpatient emergency medical services (OEMS) provide healthcare for patients with non-life-threatening conditions in need for urgent care when outpatient practices are closed. We studied the use of point-of-care-testing of C-reactive protein (CRP-POCT) at OEMS.
Design Cross-sectional questionnaire-based survey.
Setting Single centre OEMS practice in Hildesheim, Germany (October 2021 to March 2022).
Participants OEMS physicians answering a questionnaire immediately after performing CRP-POCTs (CUBE-S Analyzer, Hitado) on any patients.
Primary and secondary outcomes Impact of CRP-POCTs on clinical decision-making and perceived usefulness.
Results In the 6-month study period, 114 valid CRP-POCTs were performed in the OEMS practice by 18 physicians and the questionnaire was answered in 112 cases (response rate: 98.2%). CRP-POCTs were used in the diagnosis of inflammatory diseases of the gastrointestinal tract (60.0%), respiratory tract infections (17.0%), urinary tract infections (9.0%) and other non-gastrointestinal/non-specified infections (11.0%). The use of a CRP-POCT resulted in a change of the physicians’ clinical decision in 83.3% of the cases. Specifically, in 13.6% and 35.1% of the cases, rapid CRP measurements led to decision changes in the (1) initiation of antimicrobial therapy and (2) other drug treatment, respectively. Notably, in 60% of all cases, the use of a CRP-POCT reportedly changed the decision on hospitalisation/non-hospitalisation of OEMS patients. In respect of antimicrobial therapy and hospitalisation, these decision changes primarily (≥73%) promoted ‘step-down’ decisions, that is, no antibiotic therapy and no hospital admission. In the great majority of CRP-POCT applications (≥95%), OEMS physicians reported that rapid CRP measurements increased the confidence in their diagnostic and therapeutic decision. In almost all cases (97%), physicians rated the CRP-POCT use as useful in the treatment situation.
Conclusion Quantitative CRP-POCT promotes step-down clinical decisions and strengthens the clinical confidence of physicians in out-of-hours OEMS.
- ACCIDENT & EMERGENCY MEDICINE
- Diagnostic microbiology
- GENERAL MEDICINE (see Internal Medicine)
Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, RM, upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, RM, upon reasonable request.
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Footnotes
Contributors All authors made a significant contribution to the work reported. AM: Conceptualisation, methodology, investigation, data curation, reviewing and editing the manuscript. FW: Methodology, supervision, reviewing and editing the manuscript. EW: Conceptualisation, methodology, supervision, resources, project administration. JB: Supervision, reviewing and editing the manuscript, funding acquisition. RM: Conceptualisation, methodology, investigation, data curation, formal analysis, visualisation, writing of the original draft and is also responsible for the overall content as the guarantor. All authors gave final approval of the version to be submitted.
Funding This work was supported by the Germany Federal Ministry of Education and Research: InfectoGnostics Research Campus Jena (grant number: 13GW0461). This funding source had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data or decision to submit results.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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