@carrolenitan
Professor of Paediatric Infection, University of Liverpool. Sepsis, antimicrobial stewardship, biomarker-guided trials in infection, paediatric early warning scores, health inequalities. Personal views.
Large collaborative team effort across 3 nations. Huge thanks to all including
@gerri-sefton.bksy.social
@profberniecarter.bsky.social
@ejlim.bsky.social and others not on bsky.
8/Standardisation of PEWS creates a “common language” across different settings and aids benchmarking of practice. This study supports the widespread roll out of proposed National PEWS for England. Further validation is required in other settings.
7/ National standardised PEWS would allow collation of big data across primary to tertiary units to develop evidence-based thresholds for children admitted to hospital, modelling for weighting of PEWS components and the opportunity for periodic recalibration of age-specific risk models.
6/CDE is a more appropriate outcome measure than hospital mortality, due to low mortality in children outside PICU. Our study makes a strong case for the standardisation using the National PEWS for England
5/This is the first study to compare the predictive performance of various PEWS used in the UK and Ireland for identifying CDEs in hospitalised children. PEWS predictive performance remained very good within sub-groups such as those with cyanotic congenital heart disease or chronic hypoxia.
4/We used pre-intervention data from the DETECT study and matched 250 cases with 500 age matched controls (also matched by LOS and month of hospital admission). AUCs across all seven PEWS in predicting CDE, ranged from 0·87 to 0·95 in a heterogenous cohort.
3/The primary outcome was occurrence of a critical deterioration event (CDE) and secondary outcome 72-hour hospital mortality. CDE is defined by patients requiring unplanned admission to critical care (HDU or PICU) and initiation of organ support within the subsequent 12 hours
2/ The aim of this study was to compare the performance of seven PEWS (Alder Hey, Bedside, Bristol, Irish, Newcastle, Scottish and the proposed National PEWS for England) utilised in clinical practice in the United Kingdom and Ireland.
bmcpediatr.biomedcentral.com/articles/10....
1/ Latest paper from DETECT study led by Abbey Bracken
Excited to share our latest article in Research Professional News. We discuss the importance of recognising diverse research outputs and highlight the steps we're taking at the University of Liverpool to support them 💡
@resprofnews.bsky.social
www.researchprofessionalnews.com/rr-news-uk-v...
Hello Bluesky!
Hello Bluesky! 👋
We’re the Royal College of Paediatrics and Child Health. We represent over 24,000 paediatricians in the UK and internationally.
Follow us to hear about our work to support #Paediatricians and transform #ChildHealth.
Great thread about the real world experience of procalcitonin to guide IV antis in children. Low compliance with the algorithm, with a test that also disrupted routine workflow. Diagnostic stewardship requires careful implementation design.
Latest paper from the DIAMONDS consortium led by Antonio Salas and Federico Martinon-Torres at SERGAS, Spain
www.nature.com/articles/s41...
Interesting study on role of PCT in the stewardship of IV antibiotics for children admitted for suspected / confirmed bacterial infections.
Does not appear helpful in reducing time on IV Abx in this setting.
#IDSky #AMR #AMSsky #pediatrics
www.sciencedirect.com/science/arti...
NEWS I PCT blood test does not lower antibiotic treatment duration for hospitalised children, study led by @carrolenitan.bsky.social shows 👇
news.liverpool.ac.uk/2025/01/08/p...
@nihr.bsky.social @livunihls.bsky.social @livuni-ives.bsky.social
This was a long and challenging project but, at the end, we’ve really contributed to practice. Thank you for your leadership @carrolenitan.bsky.social! Thank you to all the team and participants.
#AMR is a risk to antibiotic failure & death, but if this happens, do we record it on death certificates? Our centre data = NO!
👉In 1 year, 4% of deaths were AMR-attributed & NONE were recorded on death certificates!👈
Need to quantify this better to increase awareness! #IDSky @jac-amr.bsky.social
16/ Huge thanks to all the team including @emmatj.bsky.social, @ceumateus.bsky.social @cawaldrom.bsky.social @kerryhood.bsky.social @saulfaust.bsky.social @jpreso.bsky.social and others not on here. Funded by @nihr.bsky.social
15/ Our results suggest that in hospitalised children treated with IV antibiotics for suspected/confirmed serious bacterial infection, a procalcitonin-guided algorithm is not effective in reducing IV antibiotic duration, especially where robust AMS programmes are already implemented
14/ The BATCH trial intervention was a PCT-guided algorithm in addition to clinical response +/-CRP. The algorithm advice was strongly suggest stop antibiotics if PCT<0.25, or consider oral switch or stop antibiotics if PCT</=0.5 OR decreased by >/=80% and PCT between 0.5-1.
13/ How does this compare with the recently published ADAPT-sepsis trial? @AdaptSepsis in @jama.com. Children are different from adults. Daily PCT testing outside ICU would not be acceptable in children. ICU more conducive to protocol adherence compared to ward settings.
12/ A better understanding of the complex interactions influencing whether/how/ why clinicians act on test results to make antibiotic prescribing decisions will improve trial intervention fidelity and facilitate implementation and scale-up of tests shown to be effective.
11/ Pragmatic designs allow real-world evaluation of clinical effectiveness, but not implementation processes, which would allow scale-up of the intervention if found to be effective. i.e. is the intervention generalisable? We need more effectiveness-implementation hybrid designs.
10/ Fourthly, and perhaps most importantly, consider the context. Most of the participants (83%) were recruited from sites with robust antimicrobial stewardship (AMS) programmes. PCT guided algorithms add little value where median duration of IV antibiotics is 100 hrs (4 days).
9/Thirdly, adherence to the PCT algorithm was low (36% @ first clinical review, 54% @ any clinical review). Lack of familiarity with interpretation of PCT testing to guide antibiotic decisions might have made it difficult to trust the PCT result and adhere to the algorithm.
8/ Secondly, we used a specific test platform (semi-automated VIDAS platform) in order to restrict access to PCT to the trial, which did not align with routine sample workflows, so results were not always available at clinical review to guide antibiotic decisions.
7/ What do these results mean? Firstly, our population were mainly based on the wards as opposed to on ICU and was very heterogenous. Our study was not powered to show differences in sub-groups e.g. UTI, pneumonia etc.
6/ The cost-effectiveness analysis concluded that procalcitonin was more costly than usual care without a significant reduction in intravenous antibiotic duration.
5/ In children with suspected/confirmed bacterial infection admitted to hospital for IV antibiotic treatment ≥48 h, the introduction of a procalcitonin-guided algorithm did not reduce duration of IV antibiotic treatment and is non-inferior to usual care for safety outcomes.