Evidence map›Paper›PMID 31208976›Full record

ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2019

Added value and cascade effects of inflammatory marker tests in UK primary care: a cohort study from the Clinical Practice Research Datalink.

Jessica Watson, Chris Salisbury, Penny Whiting, Jonathan Banks, Yvette Pyne, Willie Hamilton

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In one paragraph

Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Current and emerging approaches to manage chronic inflammatory gut disorders.Frontiers in cellular and infection microbiology · 2026
    Review
  6. Article
  7. Underlying disease risk among patients with fatigue: a population-based cohort study in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024
    Article
  8. Article
  9. Article
  10. Blood tests in primary care: A qualitative study of communication and decision-making between doctors and patients.Health expectations : an international journal of public participation in health care and health policy · 2022
    Article
  11. Article
  12. 'I guess I'll wait to hear'- communication of blood test results in primary care a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022
    Article
  13. Review
  14. Article
  15. Observational
  16. Another marker of underlying pathology.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
    Article
  17. High results.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
    Article
  18. Use of multiple inflammatory marker tests in primary care: using Clinical Practice Research Datalink to evaluate accuracy.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Jessica WatsonCentre for Academic Primary Care, Bristol Medical School, and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University of Bristol, Bristol.
Chris SalisburyCentre for Academic Primary Care, Bristol Medical School, and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University of Bristol, Bristol.
Penny WhitingCentre for Academic Primary Care, Bristol Medical School, and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University of Bristol, Bristol.
Jonathan BanksCentre for Academic Primary Care, Bristol Medical School, and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University of Bristol, Bristol.
Yvette PyneCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol.
Willie HamiltonUniversity of Exeter Medical School, University of Exeter, Exeter.

Funding

Department of Health DRF-2016-09-034
6 · The paper itself

Abstract

backgroundInflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and plasma viscosity) are commonly used in primary care. Though established for specific diagnostic purposes, there is uncertainty around their utility as a non-specific marker to rule out underlying disease in primary care.

aimTo identify the value of inflammatory marker testing in primary care as a rule-out test, and measure the cascade effects of testing in terms of further blood tests, GP appointments, and referrals. DESIGN AND

settingCohort study of 160 000 patients with inflammatory marker testing in 2014, and 40 000 untested age, sex, and practice-matched controls, using UK primary care data from the Clinical Practice Research Datalink.

methodThe primary outcome was incidence of relevant disease, including infections, autoimmune conditions, and cancers, among those with raised versus normal inflammatory markers and untested controls. Process outcomes included rates of GP consultations, blood tests, and referrals in the 6 months after testing.

resultsThe overall incidence of disease following a raised inflammatory marker was 15%: 6.3% infections, 5.6% autoimmune conditions, 3.7% cancers. Inflammatory markers had an overall sensitivity of <50% for the primary outcome, any relevant disease (defined as any infections, autoimmune conditions, or cancers). For 1000 inflammatory marker tests performed, the authors would anticipate 236 false-positives, resulting in an additional 710 GP appointments, 229 phlebotomy appointments, and 24 referrals in the following 6 months.

conclusionInflammatory markers have poor sensitivity and should not be used as a rule-out test. False-positive results are common and lead to increased rates of follow-on GP consultations, tests, and referrals.

Indexed as

Blood SedimentationPlasmaPrimary Health CareViscosityAdultAgedAutoimmune DiseasesCohort StudiesC-Reactive ProteinFemaleHumansIncidenceInfectionsInformation Storage and RetrievalMaleMiddle AgedC-Reactive Proteindiagnosisinflammatory markersprimary care

Identifiers

PMID31208976
PMCPMC6582446

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.