Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients

Centor, Robert M.; Dalton, Harry P.; Campbell, Mary S.; Lynch, Minda R.; Watlington, A. Tyler; Garner, Betty

doi:10.1007/bf02596194

Cited by 10 publications

(4 citation statements)

References 11 publications

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“…All 92 patients with a positive finding for a bacterial agent by culture or PCR were symptomatic with one or more of the following symptoms: fever, presence of exudate, lymphadenopathy, and absence of a cough. Sixty-three (68.5%) of the 92 patients presented with 2 or more of these symptoms, warranting testing for bacterial pharyngitis based on the Centor scoring system (25). However, 24 (26.1%) patients presented with coughs.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis

Van

Cox

Cox³

et al. 2017

J Clin Microbiol

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, an obligate anaerobic bacterium, was recently reported to be an important cause of bacterial pharyngitis with a prevalence as high as that of group A (GAS) in adolescents and young adults. Importantly, is the primary causative agent of the life-threatening Lemierre's syndrome, and screening of pharyngeal samples may be warranted for its early detection and prevention. The aim of this study was to determine the prevalences of and groups A and C/G streptococci as agents of bacterial pharyngitis in children. Pharyngeal samples ( = 300) were collected from pediatric patients presenting to the emergency department with signs and symptoms of pharyngitis. Overall, 10 (3.3%), 79 (26.3%), and 4 (1.3%) patients were PCR positive for , GAS, and group C/G streptococci, respectively. The prevalence of was significantly higher in patients between the ages of 14 and 20 years at 13.5% than in patients aged 14 years and younger (1.9%, < 0.001). All positive patients presented with signs and symptoms similar to GAS pharyngitis. Our data demonstrated a potential role for as a pathogen of pharyngitis among young adults, but suggests that the prevalence of is low in preadolescent patients.

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Section: Resultsmentioning

confidence: 99%

Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis

Van

Cox

Cox³

et al. 2017

J Clin Microbiol

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“…To date, throat culture is still considered by most to be the reference standard of choice when diagnosing GABHS pharyngitis [3,8]. Newly developed RADTs can be used in ambulatory care settings, with results available within minutes [51,52]. However, throat cultures and RADTs fail to distinguish between active infection and carriage, which can lead to inappropriate prescribing of antibiotics for cases of carriage [10,53].…”

Section: Discussionmentioning

confidence: 99%

Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score

Aalbers

O'Brien²,

Chan³

et al. 2011

BMC Med

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BackgroundStratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A β-haemolytic streptococcal (GABHS) pharyngitis in adults (> 14 years of age) presenting with sore throat symptoms.MethodsA systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used.ResultsA total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37).ConclusionsIndividual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care.

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“…Using SPA = 1.0 in equations 3 and 4 shows that when there are no false-positive culture results the apparent sensitivity of a rapid test is identical to the actual sensitivity SB. The apparent specificity is lower than the actual value SPBI but calculations such as those in table 3 show that the error is small for typical values of prevalence (0.3 and below). Thus, throat cultures that involve streptococcal grouping are the appropriate standard for clinical trials of rapid streptococcal antigen detection tests in the office.…”

Section: Effect Of Errors In Comparison Culturesmentioning

confidence: 78%

“…The columns on the right show the apparent sensitivity and specificity of the rapid test, calculated using For example, studies4~s~lo using sheep blood agar cultures of duplicate throat swabs demonstrate differences between the two cultures from 8% to 14% of the time, and these are probably low estimates due to conditional dependence, as discussed in Section II. This raises the question of how these errors affect conclusions about the accuracy of rapid tests.3 3 When streptococcal grouping using subcultures eliminates the false-positive results, so the specificity is 1.0. Using SPA = 1.0 in equations 3 and 4 shows that when there are no false-positive culture results the apparent sensitivity of a rapid test is identical to the actual sensitivity SB.…”

Section: Effect Of Errors In Comparison Culturesmentioning

confidence: 99%

Evaluating Rapid Tests for Streptococcal Pharyngitis

DeNeef¹

1987

Med Decis Making

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The evaluation of new rapid antigen detection tests for streptococcal pharyngitis is complicated by the presence of errors in the standard of comparison. Even "gold standard" throat cultures are not perfectly accurate. This article is an analysis of how errors in the comparison cultures affect the apparent accuracy of new tests for streptococcal pharyngitis. One of the questions addressed is whether throat cultures performed in a physician's office are accurate enough to use as a standard in a clinical trial of a new rapid test. While the accuracy of office cultures is accepted by many to be adequate for diagnostic purposes, this analysis shows that when evaluating a new test stricter conditions must be placed on the accuracy of the cultures used for comparison.

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Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients

Cited by 10 publications

References 11 publications

Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis

Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis

Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score

Evaluating Rapid Tests for Streptococcal Pharyngitis

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