Question special

The utility of the PCT may be apparent in higher-acuity patients, such as described in the ProHOSP study. In this European study, the authors used the PCT with higher acuity ER patients to determine whether antibiotics could be initiated or discontinued based on their protocol. The results showed dramatic decreases in both antibiotic days and antibiotic prescription rate. The absolute prescription rate difference was 26.8% in acute bronchitis. This means the number needed to test is ~4 to prevent one prescription of antibiotics.

However, in this study of low to moderate acuity patients, we see no statistically significant difference in antibiotic days between even the per-protocol population. But does this lack of statistical significance negate the possible clinical significance in certain subgroups? The prescription of antibiotics in patients with acute bronchitis is 17.3% vs 32.1%, ARR of 14.8%, meaning testing just 8 people will prevent 1 patient from receiving antibiotics for acute bronchitis.

I wonder what others think about the financial prudence of this test in a low-moderate acuity population.