ArticleJournal of the American College of Emergency Physicians open2025
An Assessment of C-Reactive Protein and Erythrocyte Sedimentation Rate in Ruling Out Acute Infectious Spinal Pathology in Emergency Department Patients: A Retrospective Cohort Study.
Article in Journal of the American College of Emergency Physicians open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
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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.
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.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: Acute infectious spinal pathologies (AISP), including discitis, osteomyelitis, spinal epidural abscess, and septic arthritis are rare, carry significant morbidity and mortality, and are difficult to diagnose. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are frequently elevated in AISP, although there are no consensus recommendations on using them. This retrospective study aims to calculate the biomarkers' sensitivity to rule out AISP. Methods: We retrospectively reviewed emergency department patients from a national hospital system database over 4 years who presented with spinal pain, had inflammatory biomarkers drawn, and had a spinal magnetic resonance imaging. We collected all International Classification of Diseases, Tenth Revision diagnosis codes in these patients and compared those with and without AISP. For each biomarker, we created a matched propensity analysis and created receiver-operating curves. From these, we calculated the cut points to obtain 90% and 95% sensitivity to rule out AISP. Finally, we calculated the sensitivity when using both biomarkers. Results: We identified 1963 AISP cases and 3981 controls. The median (interquartile range) for ESR was 18 (30) mm/h in controls vs 56 (54) mm/h in AISP cases, Conclusion: Low levels of CRP and ESR may help rule out AISP in emergency department patients without confirmatory imaging. Further prospective studies may be indicated to validate these findings.
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Registered trials
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