GRADE-based procalcitonin guideline for emergency departments

Abstract

Procalcitonin is a useful biomarker for infection. Over the past two decades, there has been much research on the clinical applications of procalcitonin, yet the majority of these studies have been conducted in the intensive care setting. Despite the extensive use of procalcitonin in emergency departments, there have been no guidelines focusing specifically on these clinical settings. Additionally, previous guidelines were predominantly shaped by expert consensus and rarely incorporate evidence-based medicine concepts. To address these shortcomings, the current guideline adopts a novel approach. Initially, we identified the most critical questions regarding the use of procalcitonin in emergency settings through expert voting. This was followed by a systematic literature review and the evaluation of evidence levels using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. Key characteristics of individual studies will be summarized and evaluated by the guideline development group to determine the overall quality of evidence. The GRADE working group's categorization system will be employed to rate evidence quality into four levels. Recommendations will be formulated based on explicit consideration of established criteria. This structured approach ensures that guideline recommendations are founded on robust evidence and transparently assessed for strength and potential caveats. This is the first guideline on the use of procalcitonin to be applied in emergency departments that adopts the principles of evidence-based medicine and encompasses the up-to-date literatures, and it marks an advancement in providing guidance on the utilization of procalcitonin in emergency departments.

Keywords: Antibiotic stewardship; Diagnostic performance; Guideline; Molecular testing; Procalcitonin; Septic patients.