Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates
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Ivan Gornik
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Hana Franić
Abstract
Objectives
The aim of the present study was to assess the effect of repeated laboratory measurement of C-reactive protein (CRP) and leukocyte count on the decision whether to admit or dicharge the patient with localized infections who received antibiotics at the Emergency Department (ED) observation unit.
Methods
Adult patients with respiratory, urinary tract and abdominal infections, observed at the ED after antibiotic administration, in whom repeated measurements of CRP and leukocyte count were performed within 24 h, were included. They were initially grouped as planned discharge, planned admission and unclear attitude towards admission. Initial and repeated CRP and leukocyte count results, clinical dynamics (improvement, worsening, unchanged) and clinical decision about discharge or admission, were recorded.
Results
A total of 1,038 patients were eligible for inclusion. No significant differences in initial CRP and leukocyte count values were observed, nor any association of CRP and leukocyte count changes with clinical dynamics. Among 504 patients eligible for discharge at second laboratory sampling according to clinical dynamics, 54.4 % were further observed or admitted. Discharged patients had an average negative absolute (p<0.001) and relative CRP change (p=0.002). Clinical dynamics, first and second CRP results and absolute CRP change were independently associated with the decision to discharge or further observe/admit.
Conclusions
Schematic repetitions of CRP and leukocyte count at the ED observation unit are common, regardless of patients’ clinical condition. Clinical judgment remains the main guiding factor to admit or discharge the patient, but repeated CRP testing influences the final decision, contributing to higher admission rates.
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Research ethics: The local Institutional Review Board deemed the study exempt from review.
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Informed consent: Not applicable.
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Author contributions: IG designed the study, analyzed the data and wrote the manuscript. IL acquired and analyzed the data, and wrote the manuscript. HF, BR and LM acquired and analyzed the data. DR designed the study, analyzed the data and critically revised the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The raw data can be obtained on request from the corresponding author.
References
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© 2024 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization
- Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates
- Quality control of ultrasonography markers for Down’s syndrome screening: a retrospective study by the laboratory
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Artikel in diesem Heft
- Frontmatter
- Review
- Systematic review and meta-analysis of observational studies evaluating glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCHL1) as blood biomarkers of mild acute traumatic brain injury (mTBI) or sport-related concussion (SRC) in adult subjects
- Opinion Papers
- From stable teamwork to dynamic teaming in the ambulatory care diagnostic process
- Bringing team science to the ambulatory diagnostic process: how do patients and clinicians develop shared mental models?
- Vitamin D assay and supplementation: still debatable issues
- Original Articles
- Developing a framework for understanding diagnostic reconciliation based on evidence review, stakeholder engagement, and practice evaluation
- Validity and reliability of Brier scoring for assessment of probabilistic diagnostic reasoning
- Impact of disclosing a working diagnosis during simulated patient handoff presentation in the emergency department: correctness matters
- Implementation of a bundle to improve diagnosis in hospitalized patients: lessons learned
- Time pressure in diagnosing written clinical cases: an experimental study on time constraints and perceived time pressure
- A decision support system to increase the compliance of diagnostic imaging examinations with imaging guidelines: focused on cerebrovascular diseases
- Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization
- Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates
- Quality control of ultrasonography markers for Down’s syndrome screening: a retrospective study by the laboratory
- Short Communications
- Unclassified green dots on nucleated red blood cells (nRBC) plot in DxH900 from a patient with hyperviscosity syndrome
- Bayesian intelligence for medical diagnosis: a pilot study on patient disposition for emergency medicine chest pain
- Case Report – Lessons in Clinical Reasoning
- A delayed diagnosis of hyperthyroidism in a patient with persistent vomiting in the presence of Chiari type 1 malformation
- Letters to the Editor
- Mpox (monkeypox) diagnostic kits – September 2024
- Barriers to diagnostic error reduction in Japan
- Superwarfarin poisoning: a challenging diagnosis
- Reviewer Acknowledgment
- Reviewer Acknowledgment
