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CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION

CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION. QuikRead Sales Meeting 12-15 June 2005 Helsinki FINLAND. Madis Veskimägi FAMILY PHYSICIAN`S CENTRE OF TÕSTAMAA, ESTONIA. AIM OF PRESENTATION. Short discussion of primary care “pain and charm”

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CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION

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  1. CRP RAPID TEST AS REAL SUPPORT IN CLINICAL DECISION QuikRead Sales Meeting12-15 June 2005 HelsinkiFINLAND Madis Veskimägi FAMILY PHYSICIAN`S CENTRE OF TÕSTAMAA, ESTONIA

  2. AIM OF PRESENTATION • Short discussion of primary care “pain and charm” • How looks like an ideal test in context of primary care speciality • Work arrangement with QuikRead

  3. Patient`s general condition in reception, CRP level and later course of illness. Is there any correlation. Overview of study. • Some illustrative examples of real life • Discussion and conclusion

  4. “PAIN AND CHARM” OF PRIMARY CARE • Wide spectrum of patients and problems: from infant to elderly • Need for a quick assesment of patient`s condition • Making proper plan for later management during 10-15 min in reception or in patient`s home

  5. Lack of time both doctor and patient • A lot of talk and serious complaints • Sometimes patient`s do not talk absolutely (infants, patients with dementia or stroke) • Pressure from patient for getting a useless prescription of antibiotics or admission to hospital

  6. Lack of objective data • Need for assesment course of illnes and proper intervention • Danger missing of serious condition which need a quik admission to hospital

  7. AND FINALLY AS MOST IMPORTANT....

  8. NEED FOR REDUCING ANXIETY OF PATIENT AND DOUBTFULLNESS OF DOCTOR

  9. IDEAL TEST IN PRIMARY CARE • Accuracy • Quickness • Answer for main question: • Severity of infection or tissue damage • Distinguishing viral or bacterial infection • Monitoring the course of illness • Objective data in doubt of serious illnes in well-looking patient

  10. ONE AND IDEAL TEST ABSENT, BUT TEST WHICH IS NEARLY PROPER OF PREVIOUS CRITERION IS C REACTIVE PROTEIN RAPID TEST

  11. WORK ARRANGEMENT WITH QuikRead CRP • 2-5 CRP QuikRead tests daily • Answer during reception • Equipment in examination`s room with all diagnostical equipment of rural healthcare centre

  12. “DIAGNOSTICAL ORCHESTRA”

  13. Test is usually done by doctor on the need. So we can save time and win patient`s pressure for getting any prescription etc. • QuikRead equipment is carried in homevisits when indicated

  14. PATIENT`S GENERAL CONDITION IN RECEPTION. CRP LEVEL AND LATER COURSE OF ILLNESS. OVERVIEW OF STUDY

  15. In primary care is common a mixture of somatic and light-degree of psychiatric compliants • In patients with serious complaints may have a light, self-limiting dissease

  16. Contrarily may have a well-looking patient a serious condition which need an urgent intervention • Is there any correlation-it is the subject for following study

  17. REVIEW OF STUDY • The aim of the present study was to estimatethe connections between the results of CRP rapid test, performed by rural family doctor during the ambulatory or home visit and clinical statement and later course of disease

  18. METHODOLOGY • The study material is from the time period of 01.01.2003-07.03.2004 • Performed 188 CRP rapid tests • Comparison of the quantitative results, got by Quik-Read CRP methodology and picture of disease and difficulty of situation, determined during the visit and further course of disease

  19. The ten-point scale has been used: 1 light...10 complicated • Comparing these data the following correlative relations have been calculated • The difficulty of the common statement during the visit and level of CRP. • The level of CRP and difficulty of the course of disease

  20. RESULTS • 188 rapid tests have been performed • Mean age of studied patients 36,6 y, the youngest ½ y and the oldest 94 y • 79 male and 109 female patients • The average CRP level 43,5 mg/l

  21. Indication of test depending on main problem

  22. Results grouped by CRP value and further management

  23. Comparision CRP and common statement in reception • The coefficient of correlation between the difficulty of the common statement, estimated during the visit and the CRP level is –0,23 • The correlative relation is very weak

  24. The coefficient of correlation between the CRP level, determined during the visit and the difficulty of the further course of disease is 0,79 • The correlative relation is strong

  25. SUMMARY OF STUDY • The correlation between clinical picture and severity of dissease found during examination and CRP level is weak (0,23) • Well looking patient may have severe condition and vice versa • The correlation between CRP level and complicated latter course of dissease is strong ( 0,79)

  26. ILLUSTRATIVE CASES.HOW MEDICAL THOUGHT IS CHANGED AFTER CRP RAPID TEST

  27. ACUTE PHARYNGITIS • 13 y old girl, history for a 3 days of painful swallowing, weakness and temperature 38-39 C • The case is complicated by a exessive anxiety from mother and pressure for getting at least antibiotic or admission to hospital • General condition good, medium degree rednes of throat, local tenderness of noduli

  28. INITIAL DIAGNOSIS BEFORE TESTS ACUTE PHARYNGITIS, UNKNOWN ETIOLOGY

  29. TESTS • Strep A: neg. • CRP < 8 mg

  30. DIAGNOSIS AFTER TESTSVIRAL PHARYNGITIS

  31. LATER COURSE OF ILLNESS • Prescribed painkillers and warm tea • In 2 days there absent fever and complaints

  32. TUBERCULOSIS OF LUNGS • 45 y old man, history 2 days of pain in right side of chest, temperature 37,2 C and cough • General condition is good, findings of ausculation and percussion completely normal • There was a doubt of malingering. Patient has a history of hyposocial life. He was send from city to farm as unskilled worker

  33. INITIAL DIAGNOSIS BEFORE CRP TESTCOMMON COLD

  34. CRP 127 mg/l

  35. DIAGNOSIS AFTER CRP TESTSTRONG SUSPICION OF SERIOUS CONDITION PROBABLY PULMONARY ORIGIN.IDEA FOR CHEST X-RAY

  36. NEW DIAGNOSISPNEUMONIA OR STRONG SUSPICION OF PULMONARY TUBERCULOSIS. THERE WAS PRESCRIBED COURSE OF ANTIBIOTIC (AMOXICILLIN-CLAVULANIC ACID). AFTER 4 DAYS OF TREATMENT...

  37. ...CRP 154 mg/l

  38. FINAL DIAGNOSIS BEFORE REFERRAL PULMONARY TUBERCULOSISPATIENT WAS TREATED IN DEPARTAMENT OF TUBERCULOSIS UNIVERSITY CLINIC FOR A 2 MONTH

  39. ACUTE PYELONEPHRITIS • 37 y man, history of 2-3 days for pain in lumbar region, fever 38 C • Patient work as forestman, a lot of carring heavy trees, exposition of wet and cold • General condition was satisfactory, there revealed pain on palpation right side of lumbar back

  40. INITIAL DIAGNOSIS BEFORE CRP TEST:COMMON COLD, LUMBALGIA DUE TO A HEAVY LIFTING

  41. CRP 117 mg/l

  42. NEW WORKING DIAGNOSISACUTE PYELONEPHRITIS. IDEA FOR DIP-STICK TEST OF URINE: REVEAL OF POSITIVE NITROGEN AND LEUCOCYTE

  43. FOLLOWING COURSETHERE WAS PRESCRIBED NORFLOXACIN 0,4 x3, PROPER REGIMENIN 9 DAYS LATER THERE ABSENT COMPLAINTS AND THE LEVEL OF CRP WAS...

  44. ...< 8 mg/l

  45. ACUTE MYOCARDIAL INFARCTION • 65 a man, history for 3 days for a unpleasant feeling in middle of chest, irradiating to back and left shoulder • Patient has a done physical activity, the pain begin in rest in theatre. Previous history absent • On examination general condition was good. No restriction of moving. Noticeable changes of auscultation of heart and lungs absent. BP 150/80

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