Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial

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Box 1. Eligibility criteria

Inclusion (all criteria must be present)	Exclusion (any presence of)
Suspicion of lower respiratory tract infection	Impaired immunity
Age 3 months–12 years	Severe pulmonary disease
Acute cough <21 days	Serious congenital defects
Reported fever >38 °C, <5 days	Use of systemic antibiotics and/or corticosteroids in past 4 weeks
	Judged severely ill by the GP based on symptoms and signs
	Highly suspected of having pneumonia by the GP
	Referral to specialist or emergency department deemed necessary by GP

Table 1. Characteristics of randomised children at baseline

	GP use of CRP (N = 136)	Control (N = 165)
Median age, years (range)	3 (0–11)	2 (0–11)
Female sex, n (%)	65 (47.8)	81 (49.1)
Abnormalities at auscultation, n (%)	71 (50.4)	83 (49.4)
Signs of otitis media acuta, n (%)	13 (9.2)	23 (13.7)
Signs of tonsillitis, n (%)	17 (12.1)	18 (10.7)
Mean temperature, °C	38.2	38.0
Estimated severity of illness by GP, range (mean)	0.3–8.5 (4.0)	0–8.0 (3.8)
Recruited at out-of-hours service	49 (36.0)	49 (29.7)
Low social economic status	4 (2.9)	17 (10.3)

Table 2. Recorded diagnosis by GP after medical history, physical examination, and point-of-care C-reactive protein if applicable (N = 301)

Diagnosis	n	%
Upper respiratory tract infection	93	30.9
Bronchitis	64	21.3
Pneumonia	40	13.3
Cough	27	9
Viral respiratory tract infection	14	4.7
Influenza	12	4
Fever	11	3.7
Bronchial hyperreactivity	9	3
Otitis media acuta	9	3
Lower respiratory tract infection	7	2.3
Respiratory tract infection, not specified	7	2.3
Acute laryngitis or tracheitis	1	0.3
Otitis media with effusion	1	0.3
No diagnosis noted	6	2

Table 3. Effects of CRP testing on secondary outcomes

	GP use of CRP (N = 81) n (%)	Control (N = 99) n (%)	Odds ratio (95% CI)
Re-consultation for baseline episode of illness	27 (33)	34 (34)	0.95 (0.46 to1.99)
Antibiotics for baseline episode of illness	6 (7)	8 (8)	0.94 (0.33 to 2.63)
Non-urgent referral to secondary care for baseline episode of illness	3 (4)	5 (5)	0.93 (0.18 to 4.86)
Consultation for new episode of RTI within 3 months	13 (16)	29 (29)	0.61 (0.32 to 1.17)
Antibiotics for new episode of RTI within 3 months	2 (2)	7 (7)	0.34 (0.08 to 1.39)
Non-urgent referral to secondary care for new episode of RTI	3 (4)	7 (7)	0.54 (0.10 to 2.79)