Evidence map›Paper›PMID 28969592›Full record

Trial reportBMC family practice2017

External validation study of a clinical decision aid to reduce unnecessary antibiotic prescriptions in women with acute cystitis.

Warren J McIsaac, Rahim Moineddin, Ildikó Gágyor, Tony Mazzulli

Abstract readObservational StudyPragmatic Clinical TrialValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC family practice, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed.

  1. Trial
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  4. Article
  5. Article
  6. Review
  7. Development and evaluation of a primary care antimicrobial stewardship program (PC-ASP) in Toronto, Ontario, Canada.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2021
    Article
  8. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Warren J McIsaacGranovsky-Gluskin Family Medicine Centre, Ray D. Wolfe Department of Family Medicine, Sinai Health System, Mount Sinai Hospital, 60 Murray Street, Toronto, M5T 3L9, Canada. Warren.McIsaac@sinaihealthsystem.ca.ORCID http://orcid.org/0000-0001-6504-2736
Rahim MoineddinDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Ildikó GágyorDepartment of General Practice, Göttingen University Medical Centre, Göttingen, Germany.
Tony MazzulliDepartment of Microbiology, Mount Sinai Hospital and University Health Network, Toronto, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEmpirical prescribing of antibiotics to women with symptoms of acute cystitis prior to culture results is common, but subsequent culture results are often negative. A clinical decision aid for prescribing decisions in acute cystitis was previously developed that could reduce these unnecessary antibiotic prescriptions but has not been validated. This study sought to validate this decision aid for empirical antibiotic prescribing decisions in a new cohort of women with suspected acute cystitis.

methodsExternal validation study of a clinical decision aid in 397 women with symptoms of acute cystitis, involving 230 Canadian family practitioners across Canada between 2009 and 2011. The sensitivity and specificity of the decision aid compared to a gold standard positive urine culture (defined as ≥10

resultsThere were 245/397 (61.7%) positive urine cultures. The cystitis aid sensitivity was 202/245 (82.5%, 95% Confidence Interval (CI)) = 77.1%, 86.8%), compared to 167/208 (80.3%) in the previous development cohort (p = 0.54), and 239/245 (97.6%) by family physicians in the current study (p < 0.001). Specificity was low for physicians (10/152, 6.6%) compared to the decision aid (54/152, 35.5%; p < 0.001, resulting in more antibiotic prescriptions by physicians (381/397, 96.0%) than would occur with decision aid recommendations (300/397, 75.6%, p < 0.001). Unnecessary antibiotic prescriptions where urine cultures were negative would be reduced an absolute 11.1% with cystitis aid recommendations (98/397, 24.7%) compared to usual physician care (142/397, 35.8%; p = 0.001). Urine cultures would also be reduced (97/397, 24.4% decision aid vs 351/397, 88.4% physicians; p < 0.001).

conclusionsA 3-item clinical decision aid demonstrated reproducible accuracy in two cohorts of women with acute cystitis symptoms. Clinically important reductions in total and unnecessary antibiotic use, as well as urine culture testing, could result with routine clinical use compared to current empirical physician management practices.

Indexed as

Decision Support TechniquesAcute DiseaseAdolescentAdultAgedAged, 80 and overAnti-Bacterial AgentsCanadaCystitisFemaleHumansMedical OveruseMiddle AgedProspective StudiesSensitivity and SpecificityUrinalysisAnti-Bacterial AgentsAntibiotic prescriptionsCystitisDecision aid

Identifiers

PMID28969592
PMCPMC5625594

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.