Sensitivity of C-reactive Protein Cut-off Values for Pyogenic Spinal Infection in the Emergency Department
Abstract
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 mg/l (100%, 24.8%), >10 mg/l (100%, 41.3%), >30 mg/l (100%, 61.2%), and >50 mg/l (89.4%, 69.4%). Validation sensitivities of CRP cut-off values were >3.5 mg/l (97.6%), >10 mg/l (97.6%), >30 mg/l (90.4%), and >50 mg/l (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 mg/l requires validation in other settings.
Document Details
- Document Type
- Technical Report
- Publication Date
- Dec 30, 2019
- Accession Number
- AD1101284
Entities
People
- Brit Long
- Gregory Boys
- Michael D. April
- Steven Shroyer
- Sumeru Mehta
- William T Davis
Organizations
- 59th Medical Wing