Rapid Detection of Group a Streptococcal Pharyngitis in a Pediatric Population With Optical Immunoassay

Della‐Latta, Phyllis; Whittier, Susan; Hosmer, Marion E.; Agre, Fred

doi:10.1097/00006454-199408000-00013

Cited by 28 publications

(5 citation statements)

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“…Fundamental questions about whether a RADT performed in a practice setting should be compared with a BAP culture performed in a similar setting or with a BAP culture performed in a diagnostic microbiology laboratory still remain unanswered (23). It has also been suggested in several studies that culturing the pledget (the plug separating the transport medium and swab in a transport tube) in Todd-Hewitt broth (THB) significantly increases the yield of GABHS compared with that obtained in standard BAP culture using the same throat swab (15,16,22,32). However, in other studies, the yields of GABHS from BAP and THB cultures were comparable (62,68).…”

Section: Criterion Standardmentioning

confidence: 99%

Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci

2004

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Although commercial rapid antigen detection tests (RADTs) are more expensive than blood agar plate (BAP) cultures, the advantage they offer is the speed with which they provide results. Rapid identification and consequent prompt treatment of patients with pharyngitis due to group A beta-hemolytic streptococci (GABHS) can reduce the risk of spread of GABHS, can allow patients to return to school or work sooner, and may reduce the acute morbidity of this illness. In most studies, RADTs have been compared with BAP cultures as the criterion standard. However, these comparisons are complicated by the fact that there is no universally accepted procedure for performing a BAP culture. The great majority of the RADTs that are currently available have a high specificity (i.e., 95% or greater) and a sensitivity of between 70 and 90% compared with BAP cultures. Few published studies have compared the performance of various RADTs to each other or examined the performance of various RADTs in the office setting. There is also relatively little published information about how physicians in practice actually use RADTs, but the available information suggests that many physicians do not follow recommended guidelines. While the development of easy-to-perform RADTs for the diagnosis of GABHS pharyngitis has altered clinical practice substantially, only limited data about cost-effectiveness are currently available

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Section: Criterion Standardmentioning

confidence: 99%

Rapid Diagnosis of Pharyngitis Caused by Group A Streptococci

2004

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“…10,[12][13][14][15][16][17][18][19][20][21][22][23] The sensitivity and specificity of throat culture and the OIA were calculated by using a weighted average (based on sample size) of all available published studies. Throat culture demonstrated 83.4% sensitivity and 99% specificity.…”

Section: Test Characteristicsmentioning

confidence: 99%

Does Culture Confirmation of High-sensitivity Rapid Streptococcal Tests Make Sense? A Medical Decision Analysis

Webb

1998

Pediatrics

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ABSTRACT. Objective. Since the 1990 publication of a decision analysis, in which the treatment of pharyngitis in children was evaluated, a number of assumptions important in that analysis have changed. Updating many of the assumptions and costs used in that analysis to reflect the conditions currently found in a large, suburban pediatric practice, a cost-effectiveness analysis was performed in which four strategies for the treatment of pharyngitis were considered: treat all, high-sensitivity antigen test, culture, and high-sensitivity antigen test with culture confirmation.Design. Decision analysis.Results. Using microbiology data from the 13 published studies in which a high-sensitivity antigen test (Strep A OIA; BioStar Inc., Boulder, CO) and blood agar plate culture were evaluated against a variety of gold standards, the sensitivity and specificity of the highsensitivity antigen test were 89.1% and 95%, respectively. The sensitivity and specificity of blood agar plate throat culture were 83.4% and 99%, respectively. Penicillin V was used as the treatment of choice for uncomplicated pharyngitis; erythromycin was used in cases of penicillin allergy. Rates of suppurative and nonsuppurative complications reflect those currently seen in the United States. Other assumptions and cost data were taken from a large, suburban pediatric practice and its affiliated tertiary care medical center, except where noted.Despite the potential induction of resistance and the high number of allergic reactions associated with the treat-all strategy, this strategy had the lowest average cost per patient encounter and was the most cost-effective in terms of dollars per suppurative and nonsuppurative complication prevented. Of the strategies in which a diagnostic test was used, the high-sensitivity antigen test strategy had the lowest average cost and was the most cost-effective. The high-sensitivity antigen test with culture confirmation strategy had the highest average cost and was the least cost-effective.In the sensitivity analyses, a number of assumptions used in the original model were varied within a reasonable range. Under most conditions, the treat-all strategy remained the most cost-effective strategy used. One notable exception: when the wholesale cost of the antibiotic exceeded $10.76, as would be seen if any cephalosporin were used as the primary therapy of uncomplicated pharyngitis, the high-sensitivity antigen test strategy became the most cost-effective strategy.Under most conditions, the high-sensitivity antigen test strategy was the most cost-effective of the strategies in which a diagnostic test was used. Notable exceptions included: 1) conditions in which there was a low probability of streptoccal infection, 2) the use of an antigen test whose sensitivity is inferior to that of culture, and 3) during an epidemic of acute rheumatic fever.Culture confirmation of a negative high-sensitivity antigen test is the most cost-effective testing strategy only under conditions in which the probability of acute rheumatic fever a...

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“…We used the test characteristics of the OIA rapid test as reported at our children's hospital, where the sensitivity is 80.8% and the specificity is 89.5% (S. Reising, PhD, oral communication, January 1996). These values are less favorable than the manufacturer's data (sensitivity of 98.9% and specificity of 98.4%) (K. DiSilvestro, written communication, August 1995) or those from previous studies 36,37 ; thus, the values were varied in sensitivity analyses. For the officebased testing analysis, we used a sensitivity of 84% and a specificity of 93%, with a culture sensitivity of 78% and culture specificity of 99%, as reported by Gerber et al…”

Section: Probabilitiesmentioning

confidence: 87%

“…Most were done before the advent of the rapid test, and none included the optical immunoassay (OIA) rapid test. [36][37][38] The cost data for the economic analyses were either oldfrom the 1970s-or incomplete. To reexamine the issue of how best to manage the treatment of children with sore throats in an office setting, we performed a costeffectiveness analysis.…”

Section: 60mentioning

confidence: 99%