More research is needed

I typically start my editorials by commenting on the Canadian weather as people here spend more time talking about the weather than they do about what is really happening in the world. It is now mid-May, which means that I can cycle to work today, yet I am headed to the mountains this weekend for one last downhill ski. I am not aware of any evidence on the long-term outcomes of living with erratic weather versus the ‘boring’ weather that those in more southern climates have to cope with. Many decisions made each day in pediatric offices and emergency departments would be simpler if there was a point-of-care laboratory test that could reliably differentiate bacterial from viral infections. Procalcitonin was first described as a marker for bacterial infection in 1993 (1). It is commonly measured in adults and children in Europe but for reasons that are unknown to me, use of procalcitonin has never caught on in most centres in North America. In this issue, the Cochrane review focuses on the impressive results from trials in adults with respiratory tract infections where clinicians were able to decrease the duration of antibiotic use without compromising outcomes (2). The commentaries by Enarson (3) and Irwin (4) lament the paucity of similar studies in paediatrics. As with adult studies, the best that we can hope for are high quality studies looking at outcomes when procalcitonin is used as part of an algorithm rather than studies that show the sensitivity and specificity of the test, given our crippling inability to determine even in retrospect if infections were bacterial or viral. As an aside, the one potential downside to algorithms that employ biomarkers is that they downplay clinical judgment. Often trainees need to be reminded that biomarkers are just one piece of the puzzle, and that the appearance of the patient should still over-rule the results of investigations. The Eco-Paediatrics page looks at use of corticosteroids for cystic fibrosis (5). Corticosteroids are a temporary fix for almost any condition that involves inflammation, but given their adverse event profile, they are being supplanted by other anti-inflammatory agents for long-term use wherever practical.