 |
| The Who: Rock is Dead! Long Live Rock! |
The use of procalcitonin in the real world is much like the
difference between rock music recorded in the studio versus a live performance.
Studio recordings can be heavily produced, with multiple tracks, special effects and
dub-overs. Live performances are more organic, spontaneous and sound different,
sometimes not quite like the original track. Only the really talented can do both well.
I really like this recent article on the real world use of procalcitonin in critically ill patients, published in Clinical Infectious Diseases. The article is an important reminder of the
differences between randomized controlled trials and real world implementation.
Although randomized controlled trials support the use of procalcitonin for
improved antibiotic use, the implementation of procalcitonin in non-study
settings is poorly structured, inconsistent and not associated with antibiotic
use improvements or clinical benefits.
This underscores the importance of per protocol fidelity for the reproducibility of results.
When implementing an evidence
based infection prevention intervention, the key question is as follows: will the strategy (modeled on studies supporting the intervention)
play out in the real world, and, can it be done to scale with fidelity?
If not,
do not bother.
