The abstract is read at the publisher; the summary is JClub's.
In a UK pilot sequential multiple assignment randomized trial for suspected non-ventilator-associated hospital-acquired pneumonia, 220 adults were randomized, but sputum was not produced in 92/154 (59.7%).
- Why it matters: Diagnosis is imprecise and sputum culture delays targeted prescribing, yet evidence for improving diagnostic pathways in non-ventilator-associated hospital-acquired pneumonia is limited.
- What they did: Adults with suspected nv-HAP (before a second antibiotic dose) were randomized 1:1 to low-dose thoracic CT versus CXR, then—if sputum was available—randomized 1:1 to BIOFIRE FILMARRAY Pneumonia plus Panel versus standard microbiology alone. Feasibility was assessed through 90 days across four UK hospitals, with qualitative and costing substudies.
- The result: Imaging delivery was incomplete (68.8% CT; 89.2% CXR), FAPP tests were not completed in 6/31 (19.4%), and follow-up consent was 142/220 (64.5%); a definitive trial is plausible only with improved RWPC, sputum procedures, stewardship-aligned outcomes, and routine economic data capture.
The findingWhy it mattersWhat they didThe result
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