Use of Diagnostic Tests for Presumed Lower Respiratory Tract Infection in Long‐Term Care Facilities
Bibliographic record
Abstract
OBJECTIVES: To describe the current use of diagnostic tests for management of presumed lower respiratory tract infection in selected long-term care facilities (LTCFs) in Canada and to correlate test use with facility and resident characteristics. DESIGN: Prospective, 12-month multicenter cohort study. SETTING: A convenience sample of 21 LTCFs in Canada. PARTICIPANTS: LTCF residents prescribed antimicrobial therapy for presumed lower respiratory tract infection. MEASUREMENTS: Data collection included facility characteristics, patient demographics, level of care, comorbidities, clinical presentations, diagnostic testing, and outcomes. Diagnostic test use was correlated with facility access and resident and episode characteristics. RESULTS: Forty-two percent of 1,702 episodes had chest radiography obtained, 28.5% had pulse oximetry, 23.8% had peripheral leukocyte count, and 3.3% had sputum culture. On-site access correlated with obtaining chest radiography (odds ratio (OR)=4.4; 95% confidence interval (CI)=3.2-6.0) and oximetry (OR=30.3; 95% CI=16.4-55.8). Analyses stratified according to facility found that greater test use was associated with greater premorbid functional impairment and more-severe presentations. Advance directives, time to stabilization, and mortality did not correlate with test use. In multivariate analysis, significant variability between facilities for chest radiography and oximetry remained after incorporating differences in access to diagnostic testing and other facility or resident variables. CONCLUSION: The use of diagnostic tests in the management of presumed lower respiratory tract infection in these Canadian LTCFs is highly variable. Access to diagnostic tests and severity of presentations correlate with test use but do not fully explain the variability in use in institutions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".