Impact of procalcitonin on the management of children aged 1 to 36 months presenting with fever without source: a randomized controlled trial

Am J Emerg Med. 2010 Jul;28(6):647-53. doi: 10.1016/j.ajem.2009.02.022. Epub 2010 Jan 28.


Objective: The aim of the study was to evaluate the impact of procalcitonin (PCT) measurement on antibiotic use in children with fever without source.

Method: Children aged 1 to 36 months presenting to a pediatric emergency department (ED) with fever and no identified source of infection were eligible to be included in a randomized controlled trial. Patients were randomly assigned to 1 of 2 groups as follows: PCT+ (result revealed to the attending physician) and PCT- (result not revealed). Patients from both groups also had complete blood count, blood culture, urine analysis, and culture performed. Chest radiography or lumbar puncture could be performed if required.

Results: Of the 384 children enrolled and equally randomized into the PCT+ and PCT- groups, 62 (16%) were diagnosed with a serious bacterial infection (urinary tract infection, pneumonia, occult bacteremia, or bacterial meningitis) by primary ED investigation. Ten were also found to be neutropenic (<500 x 10(6)/L). Of the remaining undiagnosed patients, 14 (9%) of 158 received antibiotics in the PCT+ group vs 16 (10%) of 154 in the PCT- group (Delta -2%; 95% confidence interval [CI], -8 to 5). A strategy to treat all patients with PCT of 0.5 ng/mL or greater with prophylactic antibiotic in this group of patients would have resulted in an increase in antibiotic use by 24% (95% CI, 15-33).

Conclusion: Semiquantitative PCT measurement had no impact on antibiotic use in children aged 1 to 36 months who presented with fever without source. However, a strategy to use prophylactic antibiotics in all patients with abnormal PCT results would have resulted in an increase use of antibiotics.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / complications
  • Bacterial Infections / diagnosis*
  • Bacterial Infections / drug therapy*
  • Calcitonin / blood*
  • Calcitonin Gene-Related Peptide
  • Child, Preschool
  • Cohort Studies
  • Emergency Service, Hospital
  • Fever of Unknown Origin / blood*
  • Fever of Unknown Origin / etiology
  • Fever of Unknown Origin / therapy*
  • Hospitalization
  • Humans
  • Infant
  • Predictive Value of Tests
  • Protein Precursors / blood*
  • Reproducibility of Results
  • Treatment Outcome


  • Anti-Bacterial Agents
  • CALCA protein, human
  • Protein Precursors
  • Calcitonin
  • Calcitonin Gene-Related Peptide