Evidence map›Paper›PMID 41851897›Full record

ArticleTrials2026

TREATment of Lower Respiratory Tract Infection in Selected Hospitals in Southern Sri Lanka (TREAT-SL): study protocol for a stepped-wedge, cluster-randomized clinical trial.

P D W D De Zoysa, S A Weerasinghe, J Gamage, M D Iglesias-Ussel, S Olague, A Obale, J A Gallis, D Palangasinghe, B Senadheera, S Vasana and 17 more

Registry-linked trialAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Trials, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06331364 (TREATment of Lower Respiratory Tract Infection in Selected Hospitals in Southern Sri Lanka), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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.

NCT06331364 narecruitingnot on this map

TREATment of Lower Respiratory Tract Infection in Selected Hospitals in Southern Sri Lanka (TREAT-SL): A Stepped-wedge Cluster Randomized Trial of an Electronic Clinical Decision Support Tool (eCDST) for the Diagnosis and Treatment of Lower Respiratory Tract Infection (LRTI) in Selected Hospitals in Southern Sri Lanka

TypeinterventionalSponsorDuke UniversityRan2026 to 2027Enrolled765ConditionsLower Resp Tract InfectionArmselectronic clinical decision support tool (eCDST) diagnostic plan
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

27 authors.

P D W D De Zoysa *Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
S A Weerasinghe *Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
J GamageDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
M D Iglesias-UsselDepartment of Medicine, Duke University School of Medicine, Durham, NC, USA.
S OlagueDuke Clinical Research Institute, Duke University, Durham, NC, USA.
A ObaleDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
J A GallisDuke Global Health Institute, Duke University, Durham, NC, USA.
D PalangasingheDepartment of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
B SenadheeraDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
S VasanaDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
C NixDepartment of Medicine, Duke University School of Medicine, Durham, NC, USA.
C K BodinayakeDepartment of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
A D S NagahawatteDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
W M D G B WijayaratneDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
M R P KurukulasooriyaDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
M PremamaliDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
U H B Y DilshanDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
J NgochoKilimanjaro Christian Medical Centre, Moshi, Tanzania.
T ØstbyeDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
E B LaberDepartment of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
M H WattDepartment of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA.
E MyersDuke Clinical Research Institute, Duke University, Durham, NC, USA.
C W WoodsDuke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
S NaggieDepartment of Medicine, Duke University School of Medicine, Durham, NC, USA.
A KennyDuke Global Health Institute, Duke University, Durham, NC, USA.
H ChakrabortyDuke Clinical Research Institute, Duke University, Durham, NC, USA.
L G TillekeratneDepartment of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. gayani.tillekeratne@duke.edu.ORCID http://orcid.org/0000-0001-6012-7271

Funding

A randomized controlled trial of a novel, evidence-based algorithm for managing lower respiratory tract infection in a resource-limited settingR01AI168420 · NIAID · DUKE UNIVERSITY · PI GAYANI TILLEKERATNE · 2022 to 2026
$3.4M
NIAID NIH HHS R01 AI168420
6 · The paper itself

Abstract

backgroundLower respiratory tract infection (LRTI) is a leading cause of hospitalization and antibacterial use globally. In low- and middle-income countries (LMICs), limited diagnostic resources contribute to inappropriate antibacterial use for LRTI. The aim of this trial is to determine the impact of an electronic clinical decision support tool (eCDST) on LRTI management in Southern Sri Lanka.

methodsThis is a prospective, open-label, stepped-wedge, cluster-randomized trial that will be conducted at three public hospitals. A total of 765 patients aged ≥ 14 years who are hospitalized with LRTI will be enrolled across 9 clusters; each cluster consists of a pair of wards (1 male and 1 female). The intervention consists of implementing an eCDST (RespiQuestAB) that physicians use on their mobile phones. RespiQuestAB integrates real-time influenza incidence in Sri Lanka with epidemiological and clinical predictors of LRTI etiology to estimate the probability of the following diagnoses: influenza, other viral (including SARS-CoV-2) infection, bacterial infection, noninfectious condition, or indeterminate. Point-of-care (POC) tests for influenza, SARS-CoV-2, Streptococcus pneumoniae, or procalcitonin are recommended if a positive result increases the probability of the associated diagnosis by at least 5%; clinicians may also order these tests independently. RespiQuestAB provides treatment recommendations regarding antibacterial and antiviral (oseltamivir) use based on the probability of diagnosis. Participants will be followed longitudinally to assess antibacterial prescription and clinical outcomes. The co-primary outcomes are as follows: (1) Duration of antibacterial prescription for the index visit and (2) a composite clinical outcome associated with worsening LRTI by day 30. Secondary outcomes include the individual clinical outcomes of the composite outcome, receipt, and duration of antibacterial and antiviral prescriptions and physician adherence to diagnostic tests and treatments recommended by RespiQuestAB. Exploratory outcomes include Desirability of Outcome Ranking (DOOR) level arranged in an ordinal scale, individual DOOR levels, and prescription of immunomodulatory therapy for SARS-CoV-2. DISCUSSION: Results of this clinical trial will provide information on the impact of the RespiQuestAB on antibacterial use and clinical outcomes among patients with LRTI in an LMIC setting.

trial registrationClinicalTrials.gov NCT06331364. Registered on March 25, 2024.

Indexed as

Anti-Bacterial AgentsDecision Support Systems, ClinicalRespiratory Tract InfectionsCOVID-19FemaleHumansInfluenza, HumanMulticenter Studies as TopicProspective StudiesRandomized Controlled Trials as TopicSARS-CoV-2Sri LankaTreatment OutcomeAnti-Bacterial AgentseCDSTLRTIProtocolSri Lanka

Identifiers

PMID41851897
PMCPMC13113038

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Registered trials

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.