Impact of Lung Ultrasound along with C-Reactive Protein Point-of-Care Testing on Clinical Decision-Making and Perceived Usefulness in Routine Healthcare for Patients with Lower Respiratory Tract Infections: Protocol for Analytical Observational Study

doi:10.3390/jcm13195770

. 2024 Sep 27;13(19):5770.

doi: 10.3390/jcm13195770.

Impact of Lung Ultrasound along with C-Reactive Protein Point-of-Care Testing on Clinical Decision-Making and Perceived Usefulness in Routine Healthcare for Patients with Lower Respiratory Tract Infections: Protocol for Analytical Observational Study

Anna Llinas^{1

2

3

4}, Eugeni Paredes^{1

5}, Joaquim Sol^{6

7}, Jose Maria Palacin^{1

2

6}, Monica Solanes^{1

2}, Javier Martinez^{2

8}, Carme Florensa^{2

9}, Laia Llort^{2

9}, Maria Teresa Castañ^{2

10}, Maria Isabel Gracia¹⁰, Josep Miquel Paül^{2

11}, Marta Ortega Bravo^{2

3

12}, Carl Llor^{3

4

13}

Affiliations

¹ Onze de Setembre Primary Care Centre, Institut Català de la Salut, 25005 Lleida, Spain.
² GRECOCAP Research Group, University Institute in Primary Care Research Jordi Gol, 08007 Barcelona, Spain.
³ University Institute in Primary Care Research Jordi Gol, 08007 Barcelona, Spain.
⁴ Centro de Investigación Biomédica en Red (CIBER) en Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain.
⁵ Department of Medicine, Faculty of Medicine, University of Lleida, 25003 Lleida, Spain.
⁶ Research Support Unit Lleida, University Institute in Primary Care Research Jordi Gol, 08007 Barcelona, Spain.
⁷ Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), 25003 Lleida, Spain.
⁸ Balaguer Primary Care Centre, Institut Català de la Salut, 25600 Lleida, Spain.
⁹ Borges Blanques Primary Care Centre, Institut Català de la Salut, 25400 Lleida, Spain.
¹⁰ Rambla de Ferran Primary Care Centre, Institut Català de la Salut, 25007 Lleida, Spain.
¹¹ Cervera Primary Care Centre, Institut Català de la Salut, 25200 Lleida, Spain.
¹² Almacelles Primary Care Centre, Institut Català de la Salut, 25100 Lleida, Spain.
¹³ Department of Public Health, General Practice, Faculty of Medicine, University of Southern Denmark, 5000 Odense, Denmark.

PMID: 39407829
PMCID: PMC11476663
DOI: 10.3390/jcm13195770

Impact of Lung Ultrasound along with C-Reactive Protein Point-of-Care Testing on Clinical Decision-Making and Perceived Usefulness in Routine Healthcare for Patients with Lower Respiratory Tract Infections: Protocol for Analytical Observational Study

Anna Llinas et al. J Clin Med. 2024.

. 2024 Sep 27;13(19):5770.

doi: 10.3390/jcm13195770.

Authors

Affiliations

¹ Onze de Setembre Primary Care Centre, Institut Català de la Salut, 25005 Lleida, Spain.
² GRECOCAP Research Group, University Institute in Primary Care Research Jordi Gol, 08007 Barcelona, Spain.
³ University Institute in Primary Care Research Jordi Gol, 08007 Barcelona, Spain.
⁴ Centro de Investigación Biomédica en Red (CIBER) en Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain.
⁵ Department of Medicine, Faculty of Medicine, University of Lleida, 25003 Lleida, Spain.
⁶ Research Support Unit Lleida, University Institute in Primary Care Research Jordi Gol, 08007 Barcelona, Spain.
⁷ Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), 25003 Lleida, Spain.
⁸ Balaguer Primary Care Centre, Institut Català de la Salut, 25600 Lleida, Spain.
⁹ Borges Blanques Primary Care Centre, Institut Català de la Salut, 25400 Lleida, Spain.
¹⁰ Rambla de Ferran Primary Care Centre, Institut Català de la Salut, 25007 Lleida, Spain.
¹¹ Cervera Primary Care Centre, Institut Català de la Salut, 25200 Lleida, Spain.
¹² Almacelles Primary Care Centre, Institut Català de la Salut, 25100 Lleida, Spain.
¹³ Department of Public Health, General Practice, Faculty of Medicine, University of Southern Denmark, 5000 Odense, Denmark.

PMID: 39407829
PMCID: PMC11476663
DOI: 10.3390/jcm13195770

Abstract

Background: Lower respiratory tract infections (LRTIs) are a significant cause of primary care consultations. Differentiating between viral and bacterial infections is critical for effective treatment and to minimize unnecessary antibiotic use. This study investigates the impact of combining lung ultrasound (LUS) with capillary blood C-reactive protein (CRP) rapid testing on clinical decision-making for patients with LRTIs. Objectives: The primary objective is to assess how the integration of CRP testing and LUS influences antibiotic prescription decisions. The study aims to quantify the percentage change in antibiotic prescriptions before and after performing LUS, following history taking, clinical examination, and CRP testing. Methods: This analytical observational study will be conducted in six primary care centers within the Health Region of Lleida, Catalonia, serving a mixed urban and rural population of approximately 105,000 residents. The study will recruit 196 patients aged 18 and over, presenting with LRTI symptoms and not treated with antibiotics in the preceding 14 days. Participants will undergo CRP testing followed by LUS during their consultation. Statistical analyses, including linear regression, bivariate analysis, Pearson or Spearman correlation, and logistic regression, will be used to evaluate the impact of LUS on clinical decisions and its predictive value in diagnosing bacterial infections. Results and Conclusions: This study will provide insights into the role of LUS combined with CRP testing in improving diagnostic accuracy and guiding antibiotic prescription decisions in primary care. The findings aim to enhance treatment protocols for LRTIs, reducing unnecessary antibiotic use and improving patient outcomes.

Keywords: lung ultrasound; point-of-care testing; primary healthcare; respiratory tract infections.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

1. Lagerström F., Engfeldt P., Holmberg H. C-reactive protein in diagnosis of community-acquired pneumonia in adult patients in primary care. Scand. J. Infect. Dis. 2006;38:964–969. doi: 10.1080/00365540500388826. - DOI - PubMed
1. Woodhead M., Blasi F., Ewig S., Garau J., Huchon G., Ieven M., Ortqvist A., Schaberg T., Torres A., van der Heijden G., et al. Guidelines for the management of adult lower respiratory tract infections—Summary. Clin. Microbiol. Infect. 2011;17:1–24. doi: 10.1111/j.1469-0691.2011.03602.x. - DOI - PubMed
1. Molero García J.M., Eugenia Carandell Jäger M., Cots Yago J.M., Llor C., Gutiérrez J.M., Saura J.P., editors. Manual de Enfermedades Infecciosas en Atención Primaria. 4th ed. Volume 1. Sociedad Española de Medicina de Familia y Comunitaria; Barcelona, Spain: 2017. Infecciones del aparato respiratorio inferior; pp. 63–79.
1. McCullough A.R., Pollack A.J., Plejdrup Hansen M., Glasziou P.P., Looke D.F., Britt H.C., Del Mar C.B. Antibiotics for acute respiratory infections in general practice: Comparison of prescribing rates with guideline recommendations. Med. J. Aust. 2017;207:65–69. doi: 10.5694/mja16.01042. - DOI - PubMed
1. Llor C., Alkorta Gurrutxaga M., de la Flor i Bru J., Carracedo B., Caamaño B., Martino S., JM C.Y. Recommendations for the use of rapid diagnosis techniques in respiratory infections in primary care. Aten. Primaria. 2017;49:426–437. doi: 10.1016/j.aprim.2017.03.010. - DOI - PMC - PubMed

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[1] Lagerström F., Engfeldt P., Holmberg H. C-reactive protein in diagnosis of community-acquired pneumonia in adult patients in primary care. Scand. J. Infect. Dis. 2006;38:964–969. doi: 10.1080/00365540500388826. - DOI - PubMed

[2] Lagerström F., Engfeldt P., Holmberg H. C-reactive protein in diagnosis of community-acquired pneumonia in adult patients in primary care. Scand. J. Infect. Dis. 2006;38:964–969. doi: 10.1080/00365540500388826. - DOI - PubMed

[3] Woodhead M., Blasi F., Ewig S., Garau J., Huchon G., Ieven M., Ortqvist A., Schaberg T., Torres A., van der Heijden G., et al. Guidelines for the management of adult lower respiratory tract infections—Summary. Clin. Microbiol. Infect. 2011;17:1–24. doi: 10.1111/j.1469-0691.2011.03602.x. - DOI - PubMed

[4] Woodhead M., Blasi F., Ewig S., Garau J., Huchon G., Ieven M., Ortqvist A., Schaberg T., Torres A., van der Heijden G., et al. Guidelines for the management of adult lower respiratory tract infections—Summary. Clin. Microbiol. Infect. 2011;17:1–24. doi: 10.1111/j.1469-0691.2011.03602.x. - DOI - PubMed

[5] Molero García J.M., Eugenia Carandell Jäger M., Cots Yago J.M., Llor C., Gutiérrez J.M., Saura J.P., editors. Manual de Enfermedades Infecciosas en Atención Primaria. 4th ed. Volume 1. Sociedad Española de Medicina de Familia y Comunitaria; Barcelona, Spain: 2017. Infecciones del aparato respiratorio inferior; pp. 63–79.

[6] Molero García J.M., Eugenia Carandell Jäger M., Cots Yago J.M., Llor C., Gutiérrez J.M., Saura J.P., editors. Manual de Enfermedades Infecciosas en Atención Primaria. 4th ed. Volume 1. Sociedad Española de Medicina de Familia y Comunitaria; Barcelona, Spain: 2017. Infecciones del aparato respiratorio inferior; pp. 63–79.

[7] McCullough A.R., Pollack A.J., Plejdrup Hansen M., Glasziou P.P., Looke D.F., Britt H.C., Del Mar C.B. Antibiotics for acute respiratory infections in general practice: Comparison of prescribing rates with guideline recommendations. Med. J. Aust. 2017;207:65–69. doi: 10.5694/mja16.01042. - DOI - PubMed

[8] McCullough A.R., Pollack A.J., Plejdrup Hansen M., Glasziou P.P., Looke D.F., Britt H.C., Del Mar C.B. Antibiotics for acute respiratory infections in general practice: Comparison of prescribing rates with guideline recommendations. Med. J. Aust. 2017;207:65–69. doi: 10.5694/mja16.01042. - DOI - PubMed

[9] Llor C., Alkorta Gurrutxaga M., de la Flor i Bru J., Carracedo B., Caamaño B., Martino S., JM C.Y. Recommendations for the use of rapid diagnosis techniques in respiratory infections in primary care. Aten. Primaria. 2017;49:426–437. doi: 10.1016/j.aprim.2017.03.010. - DOI - PMC - PubMed

[10] Llor C., Alkorta Gurrutxaga M., de la Flor i Bru J., Carracedo B., Caamaño B., Martino S., JM C.Y. Recommendations for the use of rapid diagnosis techniques in respiratory infections in primary care. Aten. Primaria. 2017;49:426–437. doi: 10.1016/j.aprim.2017.03.010. - DOI - PMC - PubMed

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Impact of Lung Ultrasound along with C-Reactive Protein Point-of-Care Testing on Clinical Decision-Making and Perceived Usefulness in Routine Healthcare for Patients with Lower Respiratory Tract Infections: Protocol for Analytical Observational Study

Affiliations

Impact of Lung Ultrasound along with C-Reactive Protein Point-of-Care Testing on Clinical Decision-Making and Perceived Usefulness in Routine Healthcare for Patients with Lower Respiratory Tract Infections: Protocol for Analytical Observational Study

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

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