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Duplicate Test Orders: C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR)

by Medical Staff Office on July 29, 2014

The AAMC Laboratory Utilization Committee has identified an approximately 70% duplicate test order rate for CRP and ESR.  This is clearly too high.  While there are certain clinical indications for ordering both tests, in most instances the CRP is the test of choice.  We will continue to monitor duplicate test ordering rates with a goal of reduction to under 20%.  We plan to selectively interview physicians who continue the practice of duplicate ordering to get mutual feedback about the clinical utility of this practice.  As a reference guide please refer to the table shown below that was published by the bpac nz better medicine organization from New Zealand.  See the full article here, which has some excellent information about ESR and CRP. Thanks to Dr. Jack Lichtenstein for consulting on this problem.

What is the best test to use in different situations?

There are few studies that compare the use of ESR and CRP, hence there are only a few conditions for which there are clear recommendations. As a result, the best approach is to consider the various clinical questions that may be posed during the course of the consultation, refer to Table 1.

Table 1: Choosing CRP or ESR

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