In odontogenic abscess, CRP above 153 mg/l meant a median of 10 days in hospital
In 61 patients with an odontogenic abscess, the median length of hospital stay ranged from 4 days with low inflammatory markers to 10 days with CRP above 153 mg/l.
Two laboratory values divide patients into groups of 4 to 10 days
A retrospective analysis from the Department of Oral and Maxillofacial Surgery of the University Hospital of Bonn covered 61 patients hospitalised between January and August 2020 for surgical drainage of an odontogenic abscess. The question was whether the length of stay can be estimated from the values recorded on admission.
The authors modelled the association of procalcitonin (PCT), C-reactive protein (CRP) and leukocyte levels with length of stay using discrete hazard logistic models, and then used a decision tree for time-to-event data to identify the groups with a prolonged stay.
By procalcitonin level the median length of stay was 5, 7 and 9 days respectively. The decision tree gave a sharper division: patients with CRP above 153 mg/l stayed a median of 10 days, while those with CRP up to 153 mg/l stayed 6 days if their PCT was above 0.03 µg/l, or 4 days if it was equal to or below that value.
The practical value of the finding lies not in shortening treatment but in planning: as early as the first day the duration can be estimated more realistically, discussed with the patient and the family, and capacity allocated.
Limitations
The sample is small (61 patients), from a single institution and a single period, and the analysis is retrospective. The decision-tree thresholds were obtained exploratorily on the same sample from which they were derived, so they need to be confirmed in an independent group before they become a rule. The abstract of the original paper is incomplete in places, so the exact boundaries of the procalcitonin categories should be checked in the full text.
For your practice
- A dental practice does not measure procalcitonin, but when you send a patient to the emergency department for an odontogenic infection, include the duration of symptoms and any antibiotic therapy given so far.
- When a patient asks how long they will stay in hospital, the answer now has a range behind it: medians in this sample ranged from 4 to 10 days, depending on the inflammatory markers.
- High CRP on admission meant a longer stay in this sample — useful information for indicating the expected duration, not a reason to delay surgical drainage.