Time to Cut the CRP
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Research by a local medical student has highlighted that some inappropriate blood tests could be costing the Welsh NHS annually over £80,000 in the assay alone, let alone the time needed to take the blood, interpret the results and review with the patient; the study has won him a prize by Britain’s oldest surgical Royal College.
These cost saving are equivalent to approximately 16 extra hip replacements or almost 90 additional cataract operations every year.
C-Reactive Protein (CRP) is a marker for inflammation; however, all patients who have surgery for trauma have inflammation as a corollary of tissue damage. A blood test for CRP after an operation therefore, in most instances, does not provide any useful additional information to the attending surgeon. The results could also be giving false positives leading to incorrect use of antibiotics in cases of non-confirmed infection.
As one of the entries to the 6th Annual All Wales Research Symposium run by the Royal College of Surgeons of Edinburgh, 23-year old Luke Galloway, together with junior doctor Dr James Glasbey, presented data to show that in one centre alone, 150 unnecessary CRP tests were done EVERY month. Scaled up to the Welsh NHS in total, removing these tests could save around £80,000 every year, with no risk to patient care.
"The CRP test is still valuable in the right circumstances, " said Luke from University Hospital of Wales in Cardiff, "But after an operation for trauma it is highly likely that there will be inflammation. Using an assay therefore to test for that inflammation isn't medically appropriate."
CRP is created in the liver as part of the acute response to a range of inflammatory issues such as rheumatoid arthritis or heart disease. In these instances, testing for this marker will give clinicians an idea of the possible level of future risk for the patient.
"Many junior doctors are taught to request a CRP test early for surgical patients during their training", continued Luke, "So this training may need to be fine tuned in the future."
When a patient has suffered trauma, or been through an operation, CRP is released due to inflammation in the tissues. CRP is also associated with systemic infections, and sepsis. Some studies therefore have demonstrated in fact that CRP is not useful for the diagnosis of sepsis in the operated patient, so should be considered with caution. When infection is not suspected, then monitoring CRP could give false positives due to the normal post-operative inflammatory response. This leads to misuse of antibiotics and problems with multi-drug resistant organisms.
The All Wales Annual research symposium gives students the opportunity to present their research and audits to their peers and a panel of eminent judges - it's a great scientific networking opportunity for the students and for the winners it is a valuable part of their CV.
According to the RCSEd President Mr. Ian Ritchie, who is also a consultant trauma and orthopaedic surgeon:
“Junior doctors and surgical trainees are at the very coalface of healthcare delivery, and as such are uniquely placed to reveal opportunities for improvement. This study is a great example of the identifying changes that benefit patients and their Health Service and is why events such as the All Wales Symposium are great platforms to highlight issues and share with the medical and surgical community.”
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