A systematic review and meta-analysis on diagnostic accuracy of point-of-care C-reactive protein devices for acute respiratory tract infections.

Acute respiratory tract infections (ARTIs) are among the most common reasons for antibiotic prescriptions globally, despite the majority being viral and self-limiting. Because clinical signs alone are often insufficient, there is a clear need for rapid diagnostic methods to support evidence-based prescribing. We assessed the effectiveness of point-of-care C-reactive protein (POCT-CRP) testing devices for distinguishing between bacterial and viral ARTIs. Our search of five databases produced 413 studies, of which 29 met criteria, and six were included in the meta-analysis. The devices with adequate performance data were QuikRead CRP, NycoCard Reader II, and FebriDx®. Overall pooled sensitivity 70% (95% CI 52-83%) and specificity 86% (95% CI 80-91%). The FebriDx showed a pooled sensitivity of 84% (95% CI 76-90%) and specificity of 87% (95% CI 82-91%). The QuikRead showed a pooled sensitivity of 35% (95% CI 30-40%) and specificity of 86% (95% CI 82-89%). The NycoCard Reader II showed a pooled sensitivity of 54% (95% CI 21-83%) and specificity of 86% (95% CI 59-96%). Although POCT-CRP testing is useful in distinguishing between bacterial and viral ARTIs and is critical for antibiotic prescription, further evidence, including cost-effectiveness analysis, is needed to determine whether the implementation of POCT-CRP improves value or merely raises healthcare expenses.