Diagnostic test accuracy of serum measurement of procalcitonin and C-reactive protein for bone and joint infection in children and adolescents: a systematic review protocol

Objective: The objective of this review is to synthesize the best available evidence for the diagnostic test accuracy of procalcitonin (PCT) compared to C-reactive protein (CRP) in diagnosing osteomyelitis (OM) and septic arthritis in hospitalized children and adolescents. Introduction: Serum measurement of PCT has been shown to outperform CRP in diagnosing adult osteoarticular infections. Before PCT can be considered as a potential diagnostic test in children and adolescents, a systematic review is required. Inclusion criteria: This review will consider studies with children and adolescents aged one month to 18 years, admitted to hospital with suspected acute osteoarticular infection. This review will consider original studies measuring the diagnostic accuracy of PCT and/or CRP in the diagnosis of acute OM or septic arthritis, defined as: positive culture or polymerase chain reaction (PCR) confirmation of an accepted pathogen from blood, bone biopsy or joint fluid aspirate and/or at least two of the following: i) purulent material from biopsy or aspirate specimen, ii) positive radiological findings of osteoarticular infection, and iii) symptoms and signs consistent with OM/septic arthritis. Methods: JBI methodology for systematic reviews of diagnostic test accuracy will be utilized. A three-step search strategy will be undertaken to find relevant studies that will be assessed and reviewed using JBI SUMARI. A standardized critical appraisal tool will be used to assess methodological quality of studies. The main outcome will be pooled sensitivity and specificity measures with 95% confidence intervals for PCT and CRP in OM or septic arthritis. Results will be presented using paired forest plots, receiver operator characteristic curves, and narrative synthesis, and will include a Summary of Findings. Systematic review registration number: PROSPERO CRD42019140276.