Identifying and treating group A streptococcal pharyngitis in children

Bitnun, Ari; McIsaac, Warren J.

doi:10.1503/cmaj.141532

Cited by 8 publications

(11 citation statements)

References 14 publications

(17 reference statements)

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“…Acute pharyngitis is a common presentation to primary care physicians and pediatric ED, accounting for 6–8% of visits each year in high-income nations [ 1 , 2 ]. While most cases of acute pharyngitis are viral in origin, 20–40% [ 1 , 3 ] of cases are caused by Group A Streptococcus (GAS) infection. 60–70% of children presenting with acute pharyngitis will be prescribed an antibiotic [ 1 , 4 ], suggesting that appropriate diagnostic testing is not always performed, and antimicrobial stewardship could be improved.…”

Section: Introductionmentioning

confidence: 99%

“…Differentiating between viral and GAS pharyngitis is difficult, with even the most experienced clinician being unable to discern the signs and symptoms reliably [ 3 ]. Clinical prediction rules (e.g., Centor criteria [ 5 ] and McIsaac score [ 6 ]) have been developed to aid clinicians in predicting GAS infection, but the performance of rules is not high enough to inform treatment without culture [ 2 , 3 , 7 ]. The reference standard for diagnosing GAS pharyngitis is a throat swab cultured on selective agar.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Rapid antigen-detecting tests (RADT) for diagnosis of GAS demonstrate excellent specificity (approximately 95%) but variable sensitivity (66%–99%) [ 3 , 9 ]. Sensitivity is influenced by disease severity, size of the bacterial inoculum obtained on the swab, and operator influence on testing technique [ 3 ]. When nursing staff and laboratory technicians perform the same RADT, diagnostic performance of technologists is significantly better, with a difference in sensitivity ranging from 14% to 34% between groups [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Operator Influence on Blinded Diagnostic Accuracy of Point-of-Care Antigen Testing for Group A Streptococcal Pharyngitis

Penney

Porter

O'Brien

et al. 2016

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Background. Acute pharyngitis caused by Group A Streptococcus (GAS) is a common presentation to pediatric emergency departments (ED). Diagnosis with conventional throat culture requires 18–24 hours, which prevents point-of-care treatment decisions. Rapid antigen detection tests (RADT) are faster, but previous reports demonstrate significant operator influence on performance. Objective. To measure operator influence on the diagnostic accuracy of a RADT when performed by pediatric ED nurses and clinical microbiology laboratory technologists, using conventional culture as the reference standard. Methods. Children presenting to a pediatric ED with suspected acute pharyngitis were recruited. Three pharyngeal swabs were collected at once. One swab was used to perform the RADT in the ED, and two were sent to the clinical microbiology laboratory for RADT and conventional culture testing. Results. The RADT when performed by technologists compared to nurses had a 5.1% increased sensitivity (81.4% versus 76.3%) (p = 0.791) (95% CI for difference between technologists and nurses = −11% to +21%) but similar specificity (97.7% versus 96.6%). Conclusion. The performance of the RADT was similar between technologists and ED nurses, although adequate power was not achieved. RADT may be employed in the ED without clinically significant loss of sensitivity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Operator Influence on Blinded Diagnostic Accuracy of Point-of-Care Antigen Testing for Group A Streptococcal Pharyngitis

Penney

Porter

O'Brien

et al. 2016

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…[25] According to the authors, none of 16 RADTs tested had good correlation with the diagnosis of GABHS by culture, particularly as the disease spectrum, the size of the bacterial inoculum and the skill of the operator all affect test performance. [25,26] Molecular methods, including PCR, offer the highest accuracy for GABHS detection (approaching 95 -100%), but widespread use is limited by limited resources. [25] CRP POCT does not distinguish between those who do or do not require antibiotic therapy.…”

Section: Acute Pharyngo Tonsillitismentioning

confidence: 99%

The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care

et al. 2016

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Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol

et al. 2021

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IntroductionStreptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing.Methods and analysisA randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3–5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed.Ethics and disseminationAll study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.Trial registration numberNCT04247243.

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Identifying and treating group A streptococcal pharyngitis in children

Cited by 8 publications

References 14 publications

Operator Influence on Blinded Diagnostic Accuracy of Point-of-Care Antigen Testing for Group A Streptococcal Pharyngitis

Operator Influence on Blinded Diagnostic Accuracy of Point-of-Care Antigen Testing for Group A Streptococcal Pharyngitis

The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care

Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol

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