Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Cost and mortality prediction using polymerase chain reaction pathogen detection in sepsis: evidence from three observational trials. | Lehmann et al. Critical Care 2010 14 R186 http content 14 5 R186 c CRITICAL CARE RESEARCH Open Access Cost and mortality prediction using polymerase chain reaction pathogen detection in sepsis evidence from three observational trials Lutz E Lehmann1 Bernd Herpichboehm2 Gerald J Kost3 Marin H Kollef4 Frank Stuber1 Abstract Introduction Delays in adequate antimicrobial treatment contribute to high cost and mortality in sepsis. Polymerase chain reaction PCR assays are used alongside conventional cultures to accelerate the identification of microorganisms. We analyze the impact on medical outcomes and healthcare costs if improved adequacy of antimicrobial therapy is achieved by providing immediate coverage after positive PCR reports. Methods A mathematical prediction model describes the impact of PCR-based rapid adjustment of antimicrobial treatment. The model is applied to predict cost and medical outcomes for 221 sepsis episodes of 189 post-surgical and intensive care unit ICU sepsis patients with available PCR data from a prospective observational trial of a multiplex PCR assay in five hospitals. While this trial demonstrated reduction of inadequate treatment days data on outcomes associated with reduced inadequate initial antimicrobial treatment had to be obtained from two other bigger studies which involved 1 147 thereof 316 inadequately treated medical or surgical ICU patients. Our results are reported with the 5 to 95 percentile ranges from Monte Carlo simulation in which the input parameters were randomly and independently varied according to their statistical characterization in the three underlying studies. The model allows predictions also for different patient groups or PCR assays. Results A total of of PCR tests enabled earlier adequate treatment. We predict that cost for PCR testing 300 test can be fully recovered for patients above 717 605 to 1 710 daily treatment cost. A to absolute reduction of mortality is expected. Cost .
