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Diagnosing streptococcal pharyngitis in the emergency department: Is a sore throat score approach better than rapid streptococcal antigen testing?

Published online by Cambridge University Press:  21 May 2015

Paul Rosenberg ,
Warren McIsaac ,
Donald MacIntosh  and
Michael Kroll
Paul Rosenberg*
Affiliation:
Department of Emergency Medicine, Etobicoke Campus of William Osler Health Centre, Toronto, Ont.
Warren McIsaac
Affiliation:
Mount Sinai Family Medical Centre, Mount Sinai Hospital, Toronto, Ont., and the Family Healthcare Research Unit, Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
Donald MacIntosh
Affiliation:
Department of Emergency Medicine, Sault Area Hospitals, Sault Ste. Marie, Ont.
Michael Kroll
Affiliation:
Department of Emergency Medicine, Credit Valley Hospital, Toronto, Ont.
*
Emergency Department, Etobicoke Hospital Campus, 101 Humber College Blvd., Etobicoke ON M9V 1R8

Abstract

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Background:

Reducing the number of unnecessary antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a clinical sore throat score in 2 community emergency departments (EDs) and its impact on antibiotic prescribing. We also attempted to improve on this approach by using a rapid streptococcal antigen test.

Methods:

A total of 126 patients with new upper respiratory tract infections accompanied by sore throat were assessed by a physician. Pharyngeal swabs were obtained for a rapid test and throat culture, and information was gathered to determine the sore throat score. The sensitivity and specificity of the score approach were compared with usual physician care based on the rapid test results.

Results:

Of the 126 cases of new upper respiratory infections with sore throat, physicians who followed their usual care routine, guided by the rapid test results, prescribed antibiotics for 46 patients. Of the 46 prescriptions, 18 were given to patients with culture-negative results for group A streptococcal (GAS) pharyngitis. Use of the sore throat score would not have reduced the number of prescriptions but would have missed only 1 patient with a positive culture result (p < 0.05). The rapid test was not as sensitive as throat culture.

Conclusions:

An explicit clinical score approach to the management of GAS pharyngitis is valid in a community ED setting and could improve the pattern of antibiotic prescribing. While the addition of a rapid streptococcal antigen test significantly decreased the sensitivity of detecting GAS infections, a combined approach consisting of the clinical score and throat culture for patients with negative results on the rapid test would decrease antibiotic prescribing and telephone follow-up without decreasing the sensitivity of detecting GAS infection.

Keywords

sore throat scorepharyngitisrapid streptococcal antigen testgroup A streptococcusemergency department
Type
EM Advances • Progrès de la MU
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 3 , May 2002 , pp. 178 - 184
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Stone, S, Gonzales, R, Maselli, J, Lowenstein, SR.Antibiotic prescribing for patients with colds, upper respiratory tract infections and bronchitis: a national survey of hospital-based emergency. Ann Emerg Med 2000;36:320–7.CrossRefGoogle ScholarPubMed
2.American Academy of Pediatrics, Committee on Infectious Disease. 1997 Red Book: Report of the committee on infectious diseases. 24th ed. Elk Grove Village (IL): American Academy of Pediatrics; 1997.Google Scholar
3.Dajani, A, Taubert, K, Ferrieri, P, Peter, G, Shulman, S.Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Pediatrics 1995;96:758–64.Google Scholar
4.Bisno, AL, Gerber, MA, Gwaltney, JM, Kaplan, EI, Schwartz, RH.Diagnosis and management of group a streptococcal pharyngitis: a practice guideline. Clin Infect Dis 1997;25:574–83.CrossRefGoogle Scholar
5.Boudreaux, ED, Ary, RD, St. John, B, Mandry, CV.Telephone contact of patients visiting a large municipal emergency department. J Emerg Med 2000;18:409–15.CrossRefGoogle ScholarPubMed
6.McIsaac, WJ, White, D, Tannenbaum, D, Lowe, DE.A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998;158:75–83.Google ScholarPubMed
7.McGinn, TG, Guyatt, GH, Wyer, PC, Naylor, CD, Stiell, IG, Richardson, WS.Users’ guides to the medical literature. XXII: How to use articles about clinical decision rules. Evidence-Based Medicine Working Group. JAMA 2000;284:79–84.CrossRefGoogle Scholar
8.Centor, RM, Witherspoon, JM, Dalton, HP, Brody, CE, Link, K.The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1:239–46.Google Scholar
9.Facklam, RR, Washington, JA.Spreptococcus and related catalase-negative gram-positive cocci. In: Balows, A, Hauser, WJ Jr, Herrmann, KL, Isenberg, HD, Shadomy, HJ, editors. Manual of clinical microbiology. 5th ed. Washington: American Society for Microbiology; 1991. p. 238–57.Google Scholar
10.Mackenzie, AMR, Li, MM, Chan, FTH.Evaluation of a kit for rapid detection of group A streptococci in a pediatric emergency department. CMAJ 1988;138:917–9.Google Scholar
11.Ebell, MH, Smith, MA, Barry, HC, Ives, K, Carey, M.The rational clinical examination. Does this patient have strep throat? JAMA 2000;284:2912–8.CrossRefGoogle ScholarPubMed
12.Griever, M.Practice tips. Incorporating a rapid group A strep assay with the sore throat score. Can Fam Physician 1999;45:1181–2.Google Scholar
13.Berke, CM.Development of rapid strep test technology. Pediatr Infect Dis 1989;8:825–8.CrossRefGoogle ScholarPubMed
14.Dubois, D, Ray, VG, Nelson, B, Peacock, JB.Rapid diagnosis of group A strep pharyngitis in the emergency department. Ann Emerg Med 1986;15:157–9.CrossRefGoogle Scholar
15.Gerber, MA.Comparison of throat cultures and rapid strep tests for diagnosis of streptococcal pharyngitis. Peditr Infect Dis J 1989;8:820–4.CrossRefGoogle ScholarPubMed
16.Gerber, MA, Randolph, MF, Chanatry, J.Antigen detection test for streptococcal pharyngitis: evaluation of sensitivity with respect to true infections. J Pediatr 1986;108:654–8.CrossRefGoogle ScholarPubMed
17.Redd, SC, Facklam, RR, Collin, S, Cohen, ML.Rapid group a streptococcal antigen detection kit: effect on antimicrobial therapy for acute pharyngitis. Pediatrics 1988;82:576–81.CrossRefGoogle Scholar
18.Roe, M, Kishiyama, C, Davidson, K, Shaefer, L, Todd, J.Comparison of BioStar Strep A OIA optical immune assay, Abbott Test-Pack Plus Strep A, and culture with selective media for diagnosis of group A streptococcal pharyngitis. J Clin Microbiol 1995;33:1551–3.CrossRefGoogle Scholar
19.Anhalt, JP, Heiter, BJ, Naumovitz, DW, Bourbeau, PP.Comparison of three methods for detection of group A streptococci in throat swabs. J Clin Microbiol 1992;30:2135–8.Google Scholar
20.Harbeck, RJ, Teague, J, Crossen, GR, Maul, DM, Childers, PL.Novel, rapid optical immunoassay technique for detection of group A streptococci from pharyngeal specimens: comparison with standard culture methods. J Clin Microbiol 1993;31:839–44.Google Scholar
21.Smith, JM.An optical immunoassay for the direct detection of group A strep antigen. Lab Med 1995;26:408–10.CrossRefGoogle Scholar
22.Supon, PA, Tunnell, S, Greene, M, Ostroff, RM.Rapid detection of group A streptococcal antigen with a new optical immunoassay. Pediatr Infec Dis J 1998;17:349–51.CrossRefGoogle Scholar
23.Gerber, MA, Tanz, RR, Kabat, W, Dennis, E, Bell, GL, Kaplan, E, Shulman, S.Optical immunoassay test for group A beta-hemolytic streptococcal pharyngitis: an office-based, multicenter investigation. JAMA 1997;277:899–903.Google Scholar
24.Heiter, BJ, Bourbeau, PP.Comparison of two rapid streptococcal antigen detection assays with culture for diagnosis of streptococcal pharyngitis. J Clin Microbiol 1995;33:1408–10.CrossRefGoogle ScholarPubMed
25.Dale, JC, Wollan, P, Cocherill, FR III. Use of optical immunoassay to diagnose streptococcal pharyngitis. JAMA 1997;278:23–4.CrossRefGoogle ScholarPubMed
26.Schlager, TA, Hayden, GA, Woods, WA, Dudley, SM, Hendley, O.Optical immunoassay for rapid detection of group A beta-hemolytic streptococci: Should culture be replaced? Arch Pediatr Adolesc Med 1996;150:245–8.CrossRefGoogle Scholar
27.Kaltwasser, G, Diego, J, Welby-Sellenriek, PL, Ferre, HR, Caparon, M, Storch, GA.Polymerase chain reaction for streptococcus pyogenes used to evaluate an optical immunoassay for the detection of group A streptococci in children with pharyngitis. Pediatr Infec Dis J 1997;16:748–53.CrossRefGoogle Scholar
28.Infectious Diseases and Immunization Committee, Canadian Paediatric Society. Rapid identification of group A beta-hemolytic streptococci in throat swabs. CMAJ 1986;134:228–9.Google Scholar
29.Pichichero, ME.Group A streptococcal tonsillopharyngitis: cost-effective diagnosis and treatment. Ann Emerg Med 1995;25: 390–403.Google Scholar
30.McIsaac, WJ, Goel, V, Lo, T, Low, DE.The validity of a sore throat score in family practice. CMAJ 2000;163:811–5.Google ScholarPubMed