Tuesday, June 13, 2017

Procalcitonin Use in the Real World: Like the Difference Between a Rock Music Studio Recording and a Live Performance

The Who: Rock is Dead! Long Live Rock!
The use of procalcitonin in the real world is much like the difference between rock music recorded in the studio versus a live performance. Studio recordings can be heavily produced, with multiple tracks, special effects and dub-overs. Live performances are more organic, spontaneous and sound different, sometimes not quite like the original track. Only the really talented can do both well.

I really like this recent article on the real world use of procalcitonin in critically ill patients, published in Clinical Infectious Diseases. The article is an important reminder of the differences between randomized controlled trials and real world implementation. Although randomized controlled trials support the use of procalcitonin for improved antibiotic use, the implementation of procalcitonin in non-study settings is poorly structured, inconsistent and not associated with antibiotic use improvements or clinical benefits.

This underscores the importance of per protocol fidelity for the reproducibility of results.

In my opinion, when attempting to implement an evidence based infection prevention intervention, the key question is as follows: will the strategy (modeled on studies supporting the intervention) play out in the real world, and, can it be done to scale with fidelity? 

If not, do not bother.

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