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Table 4 Study endpoints

From: PLUS-IS-LESS project: Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments: study protocol for a pragmatic stepped-wedge cluster-randomized trial

Primary safety endpoint

 Proportion of patients with clinical failure by day 28, defined as: death from any cause, or secondary ICU admission for any cause, or  secondary admission to hospital (excluding elective admission), or hospital re-admission after index hospital discharge (excluding elective admission), or ­ local complications due to the LRTI (empyema, lung abscess)

Primary efficacy endpoint

 Proportion of patients prescribed an antibiotic by day 28.

Secondary endpoints

 Number of points on the CAP symptom questionnaire as a surrogate marker of quality of life on days 7, 28, and 90 in each study group.

 Duration of ED stay in each study group.

 Rate and duration of hospitalization in each study group

 Proportion of patients prescribed an antibiotic for a new respiratory infection in each study group between days 28 and 90.

 Proportion of patients with antibiotic-related side effects and C. difficile infections in each study group.

 Identification of barriers and facilitators to the implementation of the algorithm with patients and ED physicians involved in the study.

 Quality-adjusted life years (QALYs), derived from responses to the EQ-5D questionnaire, in each group

 Measurement of the incremental cost-effectiveness ratio (ICER) of the intervention as compared to usual care.

 Advanced automatic LUS image analysis method using machine learning to assist in LUS diagnosis and risk stratification.

 Proportion of physician reaching proficiency in LUS image/video acquisition and interpretation after the training module.

 Sensitivity, specificity, and area under the ROC of physician “gestalt” and Van Vugt prediction score for CAP diagnosis.

Exploratory endpoints

 Proportion of LRTIs patients with a documented bacterial, viral, and mixed infection.

 Nasopharyngeal microbiome in adult Swiss patients with LRTIs.

 Urinary metabolite changes during antibiotic treatment.

 Presence and expression levels of new generation host biomarkers and transcriptome signature according to etiology and severity of the LRTI