Sensitivity of C-reactive Protein Cut-off Values for Pyogenic Spinal Infection in the Emergency Department
59MDW San Antonio United States
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To derive and internally validate a sensitive, elevated C-reactive protein CRP cut-off value among emergency department ED patients with neck or back pain concerning for pyogenic spinal infection PSI.Methods We prospectively enrolled a convenience series of adults presenting to a community ED with neck or back pain in whom ED providers had concern for PSI during 2004-2010 derivation and 2010-2018 validation. The validation cohort included only patients with PSI. We analyzed diagnostic test characteristics of various CRP cut-off values. Results We enrolled 232 patients and analyzed 201. The median age was 55 years, 43.8 were male, 4 had history of intravenous drug use, and 20.9 had recent spinal surgery. In the derivation cohort, 38 of 159 patients 23.9 had PSI. Derivation sensitivity and specificity of CRP cut-off values were 3.5 mgl 100, 24.8, 10 mgl 100, 41.3, 30 mgl 100, 61.2, and 50 mgl 89.4, 69.4. Validation sensitivities of CRP cut-off values were 3.5 mgl 97.6, 10 mgl 97.6, 30 mgl 90.4, and 50 mgl 85.7.Conclusions CRP cut-offs beyond the upper limit of normal had high sensitivity for PSI in this adult ED population. A cut-off of 30 mgl requires validation in other settings.
- Medicine and Medical Research