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

This page presents the best clinical algorithms (CA) simulated across a selection of settings. You can view the CA in two ways: SHOW THE ENTIRE TREE, to view the complete CA, or WALK THE ALGORITHM to perform a diagnostic path for a single patient.

The CA is to be used in patients with clinical suspicion (symptoms) of lower, community acquired respiratory tract infection after excluding infection by SARS-CoV-2.
The algorithm provides results by index test. Each time you consult the CA you will find:
  • number of patients used for the validation of the diagnostic path (hovering the edge);
  • distribution of the estimated probability by etiological agent in the graphic based on the tests (path);
  • distribution of etiology among patients within the validation datasets who shared the diagnostic path.
The clinical algorithm is a binary tree where nodes correspond to the point of care tests, assessed through meta-analysis and edges to their outcomes. Each clinical algorithm was built iteratively, by selecting the next index test, until maximal depth, or the desired probability for either etiology is reached. Several trees were constructed to represent different settings, i.e. availability of the tests.

The table presents all of the trees listed according to the availability of the point of care index tests. You can choose a row with the desired algorithm and visualise the entire tree or proceed to walk the clinical algorithm.

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Select tree:

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abbreviations
Etiology:
  • FLU: Influenza
  • CAP: Pneumonia / Bacterial etiology
  • VIR: Viral etiology
    • Bacterial pathogens:
  • CPNEU: Chlamydia pneumoniae
  • SPNEU: Streptococcus pneumoniae
  • MPNEU: Mycoplasma pneumoniae
    • Viral pathogens:
  • AVIR: Adenovirus
  • RhVIR: Rhinovirus
  • RSV: Respiratory Syncytial Virus
    • Biomarkers:
  • CRP: C-reactive protein
  • PCT: Procalcitonin test
  • WBC: White Blood Count
    • Imaging:
  • US: Lung Ultrasound
  • X-ray: Chest X-ray
  • RADT: Rapid Diagnostic Test
  • NAAT: Nucleic-Acid-Amplification-Tests
  • CNA: Chemiluminescent Neuroamidase Assay
  • EIA: Enzyme immunoassay
  • OIA: Optical immunoassay
  • DIF: Direct immunofluorescence assay
  • IMM: Immunochromatographic assay
  • PCR: Polymerase chain reaction
  • RT-PCR: Real-Time Polymerase chain reaction