Eficacia y seguridad de una regla de decisión para orientar el tratamiento en niños con neumonía vacunados contra neumococo. Un ensayo clínico controlado

Ferrero, Fernando; Torres, Fernando; Domínguez, Paula; Ossorio, María Fabiana

doi:10.5546/aap.2015.397

Cited by 3 publications

(5 citation statements)

References 28 publications

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“…In 19 of 27 studies, the CPR was introduced as a stand-alone tool [20, 23, 24, 26–34, 36, 38, 39, 41, 43–45]. The diagnostic CPRs and strategies tested were directive in 25 of the 27 studies, making a recommendation regarding treatment or disposition in 10 studies [19, 24, 27, 30, 31, 37, 40, 41, 44, 45], further diagnostic testing in 8 studies [23, 26, 29, 35, 36, 38, 39, 43] and both further testing and treatment in 7 studies [18, 25, 28, 32–34, 46].…”

Section: Resultsmentioning

confidence: 99%

“…In most studies (18/27), the control group intervention was variably described as ‘clinicians’ assessment’ or ‘usual care’ [19, 23, 25–32, 36, 38, 39, 41–43, 45, 46]. This ranged from control groups in which clinicians were explicitly asked not to change their usual practice, and control groups where clinicians received information on the CPRs being tested in the intervention arm, to control groups where clinicians’ actions were expected to be based on local care guidelines.…”

Section: Resultsmentioning

confidence: 99%

“…length of stay) were the primary study outcome in 5 [25–27, 36, 37]. A clinical decision was the primary outcome in 12 studies [19, 21, 23, 29, 32, 38, 39, 41, 43–45, 47], and the appropriateness of the decision was the primary outcome in 3 [34, 40, 42]. Accuracy of a diagnosis or decision was the primary outcome in 4 studies [20, 24, 30, 31].…”

Section: Resultsmentioning

confidence: 99%

“…Three studies evaluated different CPRs in patients with suspected pneumonia [32] and in patients (unvaccinated and vaccinated against pneumococcus) with non-severe community-acquired pneumonia (according to clinical criteria) of unknown aetiology [41, 45]. All three studies were judged to be at unclear or high risk of bias on 3 or more domains of bias.…”

Section: Resultsmentioning

confidence: 99%

“…All three studies were judged to be at unclear or high risk of bias on 3 or more domains of bias. Prescriptions for antibiotics were significantly reduced with use of the CPR with no difference in unfavourable outcomes between interventions [32, 41, 45].…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Systematic review of the effects of care provided with and without diagnostic clinical prediction rules

et al. 2017

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Background: Diagnostic clinical prediction rules (CPRs) are worthwhile if they improve patient outcomes or provide benefits such as reduced resource use, without harming patients. We conducted a systematic review to assess the effects of diagnostic CPRs on patient and process of care outcomes. Methods: We searched electronic databases and a trial registry and performed citation and reference checks, for randomised trials comparing a diagnostic strategy with and without a CPR. Included studies were assessed for risk of bias and similar studies meta-analysed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review of the effects of care provided with and without diagnostic clinical prediction rules

et al. 2017

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Recent Developments in Pediatric Community-Acquired Pneumonia

McCulloh

Patel

2016

Curr Infect Dis Rep

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Community-acquired pneumonia (CAP) is the most common acute infectious cause of death in children worldwide. Consequently, research into the epidemiology, diagnosis, treatment, and prevention of pediatric CAP spans the translational research spectrum. Herein, we aim to review the most significant findings reported by investigators focused on pediatric CAP research that has been reported in 2014 and 2015. Our review focuses on several key areas relevant to the clinical management of CAP. First, we will review recent advances in the understanding of CAP epidemiology worldwide, including the role of vaccination in the prevention of pediatric CAP. We also report on the expanding role of existing and emerging diagnostic technologies in CAP classification and management, as well as advances in optimizing antimicrobial use. Finally, we will review CAP management from the policy and future endeavors standpoint, including the influence of clinical practice guidelines on clinician management and patient outcomes, and future potential research directions that are in the early stages of investigation.

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Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Tramper-Stranders

2018

Paediatric Respiratory Reviews

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Community acquired pneumonia (CAP) is a leading cause of childhood morbidity worldwide. Because of the rising antimicrobial resistance rates and adverse effects of childhood antibiotic use on the developing microbiome, rational prescribing of antibiotics for CAP is important. This review summarizes and critically reflects on the available evidence for the epidemiology, etiology and antimicrobial management of childhood CAP. Larger prospective studies on antimicrobial management derive mostly from low- or middle-income countries as they have the highest burden of CAP. Optimal antimicrobial management depends on the etiology, age, local vaccination policies and resistance patterns. As long as non-rapid surrogate markers are used to distinguish viral- from bacterial pneumonia, the management is probably suboptimal. For a young child with signs of non-severe pneumonia (with or without wheezing), watchful waiting is recommended because of probable viral etiology. For children with more severe CAP with fever, a five-day oral amoxicillin course would be the first choice therapy and dosage will depend on local resistance rates. There is no clear evidence yet for superiority of a macrolide-based regimen for all ages. For cases with CAP requiring hospitalization, several studies have shown that narrow-spectrum IV beta-lactam therapy is as effective as a broad-spectrum cephalosporin therapy. For most severe disease, broad-spectrum therapy with or without a macrolide is suggested. In case of empyema, rapid IV-to-oral switch seems to be equivalent to prolonged IV treatment.

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Eficacia y seguridad de una regla de decisión para orientar el tratamiento en niños con neumonía vacunados contra neumococo. Un ensayo clínico controlado

Abstract: The use of the BPS allowed to reduce antibiotic use in the initial management of patients with pneumonia vaccinated against pneumococcal disease, without increasing the probability of an unfavorable course of the disease.

Cited by 3 publications

References 28 publications

Systematic review of the effects of care provided with and without diagnostic clinical prediction rules

Systematic review of the effects of care provided with and without diagnostic clinical prediction rules

Recent Developments in Pediatric Community-Acquired Pneumonia

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

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