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Usefulness of C-reactive Protein Testing in Assessing Acute Abdominal Pain in a GP Population

Ghosh S, Tang AH, Farrell L and Panray GB, United Kingdom

Various studies conducted in secondary care have evaluated the usefulness of C-reactive protein (CRP) testing in supplementing clinical acumen during a presentation of right iliac fossa (RIF) pain. We aim to assess the effect of point-of-care (POC) CRP testing on admissions to secondary care and the outcome of patients in general practice with RIF pain.
Patients and Methods:
We conducted a retrospective observational study of patients presenting with RIF pain during the period of June 2017 - October 2018. These patients received POC CRP testing and grouped according to levels into 3 tiers: 0-10, 11-50 and >50 mg/L which were then analysed.
A total of 113 patients were included; [69 men, 44 women], mean age[22.7 +- 12.6] years (range, 6-39years). Women who were pregnant were excluded from this analysis. Clinical evaluation and CRP testing was performed on all patients at presentation.
102 patients had CRP level 0-10mg/L. All these patients were managed in primary care and did not require hospital admission. 9patients had CRP levels between 11-50mg/L; 7 from this group were admitted to hospital based on clinical evaluation and CRP levels. 2patients had CRP levels>50mg/L and were admitted to hospital. All 104 patients managed in primary care showed full resolution of symptoms within 5 days. Of the 9 patients admitted to hospital, 7 had appendicitis, and 2 received imaging and discharged within 48 hours or less without further medical intervention.
POC CRP testing in cases of RIF pain reduced unnecessary admissions from primary care by strengthening clinicians' decision making. Furthermore it has high sensitivity when combined with clinical findings to picking up appendicitis cases. This study highlights the welcome need of such diagnostic aid to help clinicians including allied health professionals in primary care.

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