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Topic:

​

Issue:

​

Category:

Infection

Title:

CRP Predicts the Need to Escalate Care After Initial Debridement for Musculoskeletal Infection

Author:

Moore-Lotridge, Stephanie N. PhD; Daryoush, Joshua R. MD; Wollenman, Colby C. MD; Gibian, Joseph T. MD; Johnson, Samuel R. MD; Thomsen, Isaac P. MD, MSCI; Schoenecker, Jonathan G. MD, PhD

Journal:

Journal of Pediatric Orthopaedics

Date:

March 2024

Reference:

44(3): p 188-196, DOI: 10.1097/BPO.0000000000002573

Level Of Evidence:

III

# of Patients:

135

Study Type:

Retrospective comparative study

Location:

Tertiary care center

Summary:

This study investigated the use of serial C-reactive protein (CRP) measurements to predict the need for escalation of care in pediatric patients with musculoskeletal infections after initial surgical debridement.

Methods:

Patient Selection: Pediatric patients who underwent operative debridement for MSKI between September 2009 and December 2015. Laboratory Data: CRP levels were measured preoperatively and on postoperative day (POD) 2. Variables Evaluated: Patient demographics, need for escalated care, patient outcomes (disseminated disease, tissue culture positivity, length of stay, adverse outcomes).

Exclusions:

Not specified

Results:

CRP Thresholds: Preoperative CRP >90 mg/L and a positive change in CRP at POD2 effectively predicted the need for escalated care after initial debridement. Area under the Receiver Operator Curve (AUC) = 0.883 for CRP as a predictor. Risk Increase: For every 10-unit increase in preoperative CRP or postoperative change in CRP, there was a 21% or 22% increased risk of needing escalated care. Association with Adverse Outcomes: Stratification by CRP levels and change in CRP correlated with increased rates of disseminated disease, tissue culture positivity, length of stay, and adverse outcomes.

Conclusions:

Serial CRP measurements are a useful tool in predicting the need for escalated care in pediatric MSKI cases following initial debridement. These findings highlight the potential of CRP as a routine marker for monitoring infection progression and guiding treatment escalation. Future prospective studies are needed to optimize the timing of CRP reassessment and enhance clinical outcomes and patient care.

Relevance:

Limitations:

Perspective:

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