Value-Dx Clinical Algorithm to reduce inappropriate antibiotic usage for community-acquired lower respiratory tract infections

THIS WEBSITE PRESENTS the results of the META-ANALYSIS assessing accuracy OF POINT-OF-CARE TESTS FOR acute, lower, COMMUNITY-ACQUIRED RESPIRATORY INFECTIONS. THE evidence from META-ANALYSIS WAS USED TO DERIVE A CLINICAL ALGORITHM (CA) TO support THE DIAGNOSTIC PROCESS OF THE most COMMON COMMUNITY-ACQUIRED respiratory INFECTIONS. THE ALGORITHM AIMS TO REDUCE INAPPROPRIATE ANTIBIOTICS prescriptions FOR NON-BACTERIAL ACUTE, COMMUNITY-ACQUIRED LOWER RESPIRATORY INFECTIONS AND CONSEQUENTLY CURB ONE OF THE MOST CRITICAL GLOBAL DRIVERS OF ANTIBIOTIC RESISTANCE EMERGENCE.

Value-Dx project
The meta-analysis and the CAs were developed within the Work-Package 1 (WP1) of the Value-Dx project. Value-Dx is an IMI-funded project aiming at combating antibiotic resistance emergence by reducing inappropriate antibiotic usage through improving diagnosis across community-settings.

Aims
The CA provides support to the general practitioner in the diagnosis of acute community-acquired lower respiratory infections based on symptoms, clinical assessment, and point of care tests (POCTs), including chest X-Ray and Lung Ultrasound (US). The CA reports number of patients assessed at each diagnostic step, depending on the specific symptoms, radiological and laboratory results and provides probability of the bacterial and viral etiology by assessed POCT.

Methods
The meta-analysis results have been published in the Diagnostic accuracy of point-of-care tests in acute community acquired-lower respiratory tract infections. A systematic review and meta-analysis. The meta-analysis page summarizes the results in an interactive manner.

The CA is a binary decision tree, with nodes constituting index tests assessed with the comprehensive meta-analysis and the connections between the tests, showing their possible outcomes. The CAs are created via a recursive heuristic algorithm. Briefly, at each of the nodes, the next node or the POCTs is selected randomly from the weighted list of the available tests. Each CA is internally validated with patient-level data. The simulation runs until the rarefaction curve flattens.

You can explore the CA in two ways: either by interacting with it in its entirety, or by walking the tree sequentially by answering the questions about the outcomes of the diagnostic tests. Both visualizations are available after selecting the tree from the list depending on the availability of the POCTs, on the Clinical Algorithms page.

patient-level databases
The CA were tested using the following datasets of patients with acute community acquired lower respiratory tract infections:

SARS-COV-2
At the moment, due to the ongoing SARS-CoV-2 pandemic, the CA does not include diagnosis of COVID-19. During the current epidemiological scenario all patients with symptoms of acute, community acquired lower respiratory infections, are routinely tested for the SARS-CoV-2. However, the Value-Dx WP1 team has completed a systematic review of Nucleic-Acid-Amplification-Techniques (NAAT)-based POCTs for COVID-19 diagnosis, available at: Nucleic acid amplification tests on respiratory samples for the diagnosis of coronavirus infections: a systematic review and meta-analysis. The CA will be updated with the differential diagnosis of SARS-CoV-2 as soon the dynamics of the global number of cases allow.

Disclaimer and license
The software is provided "as is" and the author disclaims all warranties with regard to this software including all implied warranties of merchantability and fitness. In no event shall the author be liable for any special, direct, indirect, or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of this software.