The value of C-reactive protein in emergency medicine

Performance evaluation of the LumiraDx quantitative microfluidic point-of-care CRP test

C-reactive protein (CRP) is an established acute-phase marker for infection, inflammation and tissue injury, used to guide clinical decision-making in primary and secondary care. This study compared the analytical performance of the quantitative microfluidic point-of-care LumiraDx CRP Test to a laboratory-based reference method (Siemens RCRP Flex assay on the Dimension® Xpand®) and evaluated equivalence of sample matrices (blood versus plasma) in point-of-care settings using samples from patients presenting with symptoms of infection or inflammation. The LumiraDx CRP Test demonstrated close agreement with the lab reference test (range, 5.1 to 245.2 mg/L, r = 0.992, slope = 0.998, intercept = -0.476; n = 205) and notable agreement between fingerstick and venous blood and plasma (r = 0.974-0.983; n = 44). Paired replicate precision had mean coefficients of variation of 6.4 % (plasma), 6.6 % (capillary direct) and 8.1 % (venous blood); overall error rates were 2.9 %. The quantitative LumiraDx CRP Test showed robust analytical performance across sample matrices and close agreement compared to the laboratory reference method when used at the point of care.

Crowned dens syndrome: An uncommon mimic of meningitis in the emergency department

Crowned dens syndrome is characterized by severe neck pain with stiffness of the neck, sometime febrile, due to calcification of the transverse atlas ligament. We describe the case of a 65-year-old woman referred to the emergency department with a suspicion of meningitis. Several anamnestic and clinical signs ruled out this hypothesis. Re-evaluation of the CT images enabled us to reach the final diagnosis of crowned dens syndrome.

A Retrospective Review of Patient Records and Factors Associated with Decisions Made by Community Nurse-Paramedics' in Finland

Community paramedicine (CP) has extended the role of paramedics and the main goal is to provide non-emergency care, which reduces the visits to emergency departments. The aim of this study was to describe the Finnish CP and examine the factors that were involved in CNPs' decision-making processes. The study was based on data from 450 consecutive CP patient records from three hospital districts. A more detailed analysis was carried out on 339 cases in patients' homes and elderly care homes, and the data analysis included multivariate logistic regression to examine the impact of variables on the CNPs' decisions. These patients' most common health issues were general weakness (15.9%) and fever (10.6%), and over half (58.7%) could remain at home after the CP visit. There were five independent factors associated with the CNPs' decisions of the patient's care continuum: the hospital district, if the patient could walk, whether the troponin test was performed, a physician was consulted, and the nature of the task. CP units played a valuable role in non-emergency care. Understanding the factors associated with CNP decision-making can increase the safety and effectiveness of reducing hospital visits, by providing patient care at home, or in elderly care facilities.

The role of presepsin in the diagnosis of chronic obstructive pulmonary disease acute exacerbation with pneumonia

Aim: In this study, we aimed to investigate the role of presepsin in detecting concomitant pneumonia in patients presenting with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency department. Patients & methods: Three groups were formed in the study. Group 1: patients diagnosed with acute exacerbation of COPD; group 2: patients with acute exacerbation of COPD + pneumonia; group 3: healthy individuals. Results: Presepsin levels of the patients in group 2 were significantly higher than those of group 1 and group 3 (p < 0.05). There was a statistically significant difference in erythrocyte sedimentation rate, CRP, procalcitonin and presepsin values between two patient groups (p < 0.05). Conclusion: Presepsin can be used to diagnose pneumonia in patients with acute exacerbation of COPD admitted to the emergency department.