Page 15 - Demo

Highlights of EAP 202315PresenterUp to 30% of primary care visits in children are related to fever, of which, in as many as 40% of cases, children are subjected to antibiotic treatment. Several point-ofcare tests (POCTs), such as urine sticks, Strep-test, viral rapid tests (influenza/covid), CRP, and glucose are at the disposal of clinicians. However, there is insufficient evidence on the role of these POCTs in evaluating febrile children and making therapeutic decisions in the primary care setting. Furthermore, the contribution of POCTs in identifying at-risk children for serious infections remains debatable. Therefore, Dr. Rianne Oostenbrink examined the evidence from clinical studies on the value of POCTs in primary pediatric care in this talk. First, Dr. Oostenbrink examined the value of urine sticks in identifying missed urinary tract infections in febrile children, especially in infants. It was pointed out that urine sticks negative for leukocyte esterase and nitrite could be used to rule out urinary tract infections (Figure 1). However, the use of clinical scoring, i.e. The Febrile Child: Value of POCTs in Primary CareRianne Oostenbrink Sophia Children%u2019s HospitalErasmus Medical CenterThe NetherlandsUTICalc or Gorelick scores, could also decrease the number of missed urinary tract infections. Next, Dr. Oostenbrink examined the issue of using POCT CRP to detect serious bacterial infections. Though the threshold values of <20 g/L of CRP can rule out and that >80 g/L can rule in a serious bacterial infection, the routine use of this strategy in all febrile children is not recommended because a clinical trial showed that using CRP based on clinical risk was highly effective at identifying serious bacterial infections. It was pointed out that Feverkidstool is an effective clinical scoring system for this purpose. Similarly, the FeverPAIN clinical score is an effective scoring tool for offering a Strep-test in case of sore throat. Dr. Oostenbrink concluded that clinical assessment is extremely important in children with fever. POCT tests have limited value, only in combination with clinical signs. However, urine POCT testing can add value by identifying missed urinary tract infections. Oral antibiotics are not indicated in children with fever without an obvious source. Nevertheless, safety-netting instructions are essential when discharging the child. Figure 1: Using urine sticks to rule out urinary tract infections.Figure 2: Trial comparing routine versus risk-based CRP POCT.Ruling out UTIdipstick negative for LE and nitrite microscopic analysis negative for pyuria and bacteriuria of a CVU, bag, or nappy/pad specimen may reasonably be used to rule out UTIWhiting et al, BMC ped, 2005