A febrile child in the Hospital Emergency Department (HED) is often a major diagnostic and therapeutic challenge. Due to the not always characteristic clinical symptoms associated with fever in children, in the differential diagnosis of the majority of cases, acute infections should be considered, both viral and bacterial. The distinction between a viral and a bacterial infection determines the appropriate treatment – which is particularly important in the era of the increasing bacterial resistance to antibiotics, leading to the need for a rationalization of therapy (1, 2). Due to the significance of the problem, attempts have been made to develop helpful algorithms. In April 2013, Ruud Nijman G et al. (3), on the basis of research conducted in two countries (the Netherlands and England) and three clinical centers, developed an algorithm for children in the emergency department. They found that the clinical parameters that should be taken in assessing the patient’s state are: sex, respiratory and heart rate, height and duration of fever, capillary return, retraction of intercostal spaces during breathing, the overall appearance of the child, the oxygen saturation, and from among the laboratory parameters – the C-reactive protein level.

C-reactive protein (CRP) is a protein synthesized by the liver, the production of which is induced by an inflammation caused by an infection or a tissue destruction process (4). It means that the CRP level, in combination with the assessment of the patient’s clinical state may be an effective method in determining the etiology of the infection (viral or bacterial), which then allows a rationalization of the treatment and prevents, for example, unnecessary antibiotic treatment. The determination of the CRP is usually performed in the blood serum obtained by taking venous blood. The waiting time for the test results depends on the efficiency of the procedures – delivery of the material to the laboratory, registration and obtaining the serum samples, the type of equipment used in the diagnostics, as well as the transfer time of the results to the doctor. In order to shorten the waiting time for the CRP test results, the rapid diagnostic test was developed (Orion Diagnostica).

Presentation of three cases of an infectious disease in which the CRP test performed using a rapid diagnostic method had a significant impact on the treatment decisions.

At the Bielanski HED, in the period from November 2013 to May 2014, the rapid diagnostic test was performed in 206 children in order to differentiate the infection. Out of the total number of children tested using the assay, we selected three cases.

The CRP concentration was determined by the immuno-turbidimetric method using the Quick Read Orion Diagnostica kit, in accordance with the instructions. The study was performed using capillary blood, drawn into the capillary after a puncture of the fingertip. The doctor was responsible for the correct performance of the test procedures. The result was known after about 2 minutes. The decision to do the test was taken by the HED doctor after the anamnesis and examining the patient. The staff had previously been trained to use the device.