Objective:
To synthesize the best available evidence for the diagnostic test accuracy of procalcitonin (PCT) compared to C-reactive protein (CRP) in diagnosing osteomyelitis (OM) and septic arthritis, in hospitalized children and adolescents.
Introduction:
Serum measurement of PCT has been shown to outperform CRP in diagnosing adult osteoarticular infections. Before PCT can be considered as a potential diagnostic test in children and adolescents, a systematic review is required.
Inclusion criteria:
Children and adolescents aged one month to 18 years, admitted to hospital with suspected acute osteoarticular infection. Original studies measuring the diagnostic accuracy of PCT and/or CRP in the diagnosis of acute OM or septic arthritis, defined as: positive culture or polymerase chain reaction (PCR) confirmation of an accepted pathogen from blood, bone biopsy or joint fluid aspirate and/or at least two of the following: 1) purulent material from biopsy or aspirate specimen; 2) positive radiological findings of osteoarticular infection; 3) symptoms and signs consistent with OM/septic arthritis.
Methods:
JBI methodology for systematic reviews of diagnostic test accuracy will be utilized. A three-step strategy will be undertaken to find relevant studies that will be assessed and reviewed using JBI SUMARI. A standardized critical appraisal tool will assess methodological quality of studies. The main outcome will be pooled sensitivity and specificity measures with 95% confidence intervals for PCT and CRP in OM or septic arthritis. Results will be presented using either paired forest plots, receiver operator characteristic curves and narrative synthesis, and will include a summary of findings table.
Systematic review registration number:
CRD42019140276.
Correspondence: Brett Ritchie, brett.ritchie@sa.gov.au
The authors declare no conflict of interest.
© 2019 by Lippincott williams & Wilkins, Inc.