Introduction
In the fast-paced environment of emergency departments (EDs), the timely identification and management of sepsis are crucial. The PRONTO study, "PROcalcitonin and NEWS2 evaluation for Timely identification of sepsis and Optimal use of antibiotics in the emergency department," presents a promising approach to improve sepsis management. This multicentre, open-label, randomized controlled trial aims to integrate the biomarker procalcitonin (PCT) with the National Early Warning Score 2 (NEWS2) to enhance the identification of sepsis and optimize antibiotic use.
Understanding the PRONTO Study
The PRONTO study is conducted across up to 20 NHS EDs in the UK, targeting a sample size of 7676 participants. It compares standard clinical management based on NEWS2 scoring alone with an approach that includes PCT-guided risk assessment. The study's primary goal is to determine if adding PCT measurement to NEWS2 scoring can reduce unnecessary antibiotic prescriptions without increasing mortality.
Key Findings and Implications
The study's coprimary endpoints focus on the initiation of intravenous antibiotics within three hours and 28-day mortality. By incorporating PCT, the study aims to address the issue of overprescription of antibiotics, a common problem due to the overemphasis on NEWS2 scores in isolation. The findings suggest that PCT can help differentiate bacterial infections, thereby supporting appropriate antibiotic prescribing.
For practitioners, the integration of PCT with NEWS2 scoring could mean:
- More accurate identification of bacterial infections.
- Reduction in unnecessary antibiotic use, combating antimicrobial resistance.
- Improved patient outcomes with no increase in mortality rates.
Encouraging Further Research
While the PRONTO study provides valuable insights, it also highlights the need for further research. Practitioners are encouraged to explore the following areas:
- Long-term outcomes of PCT-guided antibiotic stewardship.
- Integration of PCT in different clinical settings beyond the ED.
- Cost-effectiveness of implementing PCT testing on a broader scale.
Conclusion
The PRONTO study underscores the potential of combining PCT with NEWS2 scoring to enhance sepsis management in EDs. By adopting this approach, practitioners can improve diagnostic accuracy and optimize antibiotic use, ultimately leading to better patient care. As the healthcare landscape continues to evolve, embracing evidence-based practices such as those outlined in the PRONTO study will be key to advancing patient outcomes.
To read the original research paper, please follow this link: PROcalcitonin and NEWS2 evaluation for Timely identification of sepsis and Optimal use of antibiotics in the emergency department (PRONTO): protocol for a multicentre, open-label, randomised controlled trial.
