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Lung ultrasound and procalcitonin, improving antibiotic management and avoiding radiation exposure in pediatric critical patients with bacterial pneumonia: a randomized clinical trial
dc.contributor.author | Guitart Pardellans, Carmina | |
dc.contributor.author | Bobillo Pérez, Sara | |
dc.contributor.author | Rodriguez-Fanjul, Javier | |
dc.contributor.author | Carrasco, José Luis | |
dc.contributor.author | Brotons de los Reyes, Pedro | |
dc.contributor.author | López‑Ramos, Maria Goretti | |
dc.contributor.author | Cambra, Francisco-José | |
dc.contributor.author | Balaguer, Mònica | |
dc.contributor.author | Jordan, Iolanda | |
dc.date.accessioned | 2024-05-16T14:48:21Z | |
dc.date.available | 2024-05-16T14:48:21Z | |
dc.date.issued | 2024 | |
dc.identifier.citation | Guitart Pardellans, Carmina; Bobillo Perez, Sara; Rodriguez-Fanjul, Javier [et al.]. Lung ultrasound and procalcitonin, improving antibiotic management and avoiding radiation exposure in pediatric critical patients with bacterial pneumonia: a randomized clinical trial. European Journal of Medical Research, 2024, 29, 222. Disponible en: <https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-024-01712-y>. Fecha de acceso: 16 may. 2024. DOI: 10.1186/s40001-024-01712-y | ca |
dc.identifier.issn | 2047-783X | ca |
dc.identifier.uri | http://hdl.handle.net/20.500.12328/4233 | |
dc.description.abstract | Background: Pneumonia is a major public health problem with an impact on morbidity and mortality. Its management still represents a challenge. The aim was to determine whether a new diagnostic algorithm combining lung ultrasound (LUS) and procalcitonin (PCT) improved pneumonia management regarding antibiotic use, radiation exposure, and associated costs, in critically ill pediatric patients with suspected bacterial pneumonia (BP). Methods: Randomized, blinded, comparative effectiveness clinical trial. Children < 18y with suspected BP admitted to the PICU from September 2017 to December 2019, were included. PCT was determined at admission. Patients were randomized into the experimental group (EG) and control group (CG) if LUS or chest X-ray (CXR) were done as the first image test, respectively. Patients were classified: 1.LUS/CXR not suggestive of BP and PCT < 1 ng/mL, no antibiotics were recommended; 2.LUS/CXR suggestive of BP, regardless of the PCT value, antibiotics were recommended; 3.LUS/CXR not suggestive of BP and PCT > 1 ng/mL, antibiotics were recommended. Results: 194 children were enrolled, 113 (58.2%) females, median age of 134 (IQR 39–554) days. 96 randomized into EG and 98 into CG. 1. In 75/194 patients the image test was not suggestive of BP with PCT < 1 ng/ml; 29/52 in the EG and 11/23 in the CG did not receive antibiotics. 2. In 101 patients, the image was suggestive of BP; 34/34 in the EG and 57/67 in the CG received antibiotics. Statistically significant differences between groups were observed when PCT resulted < 1 ng/ml (p = 0.01). 3. In 18 patients the image test was not suggestive of BP but PCT resulted > 1 ng/ml, all of them received antibiotics. A total of 0.035 mSv radiation/patient was eluded. A reduction of 77% CXR/patient was observed. LUS did not significantly increase costs. Conclusions: Combination of LUS and PCT showed no risk of mistreating BP, avoided radiation and did not increase costs. The algorithm could be a reliable tool for improving pneumonia management. | ca |
dc.format.extent | 13 | ca |
dc.language.iso | eng | ca |
dc.publisher | Springer Nature | ca |
dc.relation.ispartof | European Journal of Medical Research | ca |
dc.relation.ispartofseries | 29 | |
dc.rights | This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. | ca |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.subject.other | Pneumònia infantil | ca |
dc.subject.other | Ecografia pulmonar | ca |
dc.subject.other | Procalcitonina | ca |
dc.subject.other | Prescripció d'antibiòtics | ca |
dc.subject.other | Radiació | ca |
dc.subject.other | Costos | ca |
dc.subject.other | Atenció crítica pediàtrica | ca |
dc.subject.other | Neumonía infantil | ca |
dc.subject.other | Ultrasonido pulmonar | ca |
dc.subject.other | Procalcitonina | ca |
dc.subject.other | Prescripción de antibióticos | ca |
dc.subject.other | Radiación | ca |
dc.subject.other | Costos | ca |
dc.subject.other | Cuidados críticos pediátricos | ca |
dc.subject.other | Childhood pneumonia | ca |
dc.subject.other | Lung ultrasound | ca |
dc.subject.other | Procalcitonin | ca |
dc.subject.other | Antibiotic prescription | ca |
dc.subject.other | Radiation | ca |
dc.subject.other | Costs | ca |
dc.subject.other | Pediatric critical care | ca |
dc.title | Lung ultrasound and procalcitonin, improving antibiotic management and avoiding radiation exposure in pediatric critical patients with bacterial pneumonia: a randomized clinical trial | ca |
dc.type | info:eu-repo/semantics/article | ca |
dc.description.version | info:eu-repo/semantics/publishedVersion | ca |
dc.rights.accessLevel | info:eu-repo/semantics/openAccess | |
dc.embargo.terms | cap | ca |
dc.subject.udc | 61 | ca |
dc.identifier.doi | https://dx.doi.org/10.1186/s40001-024-01712-y | ca |
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