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Master Thesis

Évaluation de l'impact du taux de protéine C-réactive sur la décision d'hospitalisation des patients suspects d'infection par les médecins urgentistes

Abstract : Introduction: The interest of CRP in emergency department has been widely investigated, but it’s influence on physicians decision making is not really described, especially about decision to keep in hospital or discharge. Method: It is a retrospective study, with intra-individual agreement analysis, led in two hospitals and concerning 110 patients admitted in Caen’s hospital. The result of CRP, diagnostic, prescriptions and decision of hospitalization or discharge were removed from the medical records. These records were then evaluated by 21 physicians of Caen’s Hospital and 15 physicians of Saint-Lo’s hospital. The reader was asked if he would choose to keep in hospital or discharge, then he learned the result of CRP measurement before answering again the same question. The agreement between the two decisions was measured using the Cohen’s Kappa. Results: The readers changed their decisions for only 5.4% of the patients in Saint-Lô and 3.6% in Caen. The agreement measured with Cohen’s kappa was excellent in both hospitals (k=0,927 for Caen and k=0.89 for Saint-Lo). The subgroup analysis showed that patients with inflammatory disease and patients treated with immunosuppressive agent had the worst agreement. Conclusion: CRP is not a major parameter of emergency department physician’s decision to keep in hospital or discharge patients with suspected infection. In patients with inflammatory disease and/or treated with immunosuppressive agents, CRP is difficult to interpret and should not be used to exclude the diagnostic of infection.
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Master Thesis
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Hadrien Tabard. Évaluation de l'impact du taux de protéine C-réactive sur la décision d'hospitalisation des patients suspects d'infection par les médecins urgentistes. Médecine humaine et pathologie. 2019. ⟨dumas-02483134⟩

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