Group A Streptococcal Pharyngitis Testing Appropriateness in Pediatric Acute Care Settings.

Creator(s)

Alaina Linafelter, Children's Mercy HospitalFollow
Alaina N. Burns, Children's Mercy HospitalFollow
Brian R. Lee, Children's Mercy HospitalFollow
Angela Myers, Children's Mercy HospitalFollow
Allison Burris, Children's Mercy HospitalFollow
Heather Jones, Children's Mercy HospitalFollow
Jarrod Dusin, Children's Mercy HospitalFollow
Rana El Feghaly, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

1-1-2022

Identifier

DOI: 10.1097/PEC.0000000000002223

Abstract

OBJECTIVE: Acute pharyngitis is one of the most common causes of ambulatory clinic visits; however, group A Streptococcus accounts for less than a third. National guidelines recommend against streptococcal testing in patients with viral features. This study aims to assess the rate of inappropriate streptococcal rapid antigen detection tests (RADT)s in children evaluated in urgent care clinics (UCC)s and emergency department (ED)s at a children's hospital.

METHODS: We retrospectively reviewed charts of 10% of children 3 years or older with RADTs ordered between April and September 2018 at EDs and UCCs. The test was determined to be inappropriate if the patient had no sore throat and/or had 2 or more viral symptoms: rhinorrhea/congestion, cough, diarrhea, hoarseness, conjunctivitis, or viral exanthem.

RESULTS: Over the study period, 7678 RADTs were performed, of which 7024 (91.2%) were in children 3 years or older. We evaluated 708 charts and found 44% of RADTs were inappropriate. The predicted probability of inappropriate RADT was highest among patients with a triaged reason for visit for respiratory complaints (70.5%), viral upper respiratory tract infection (69.7%), and rash (61.3%). Of the inappropriate RADTs, 20.1% were positive, whereas 32.2% of the appropriate RADTs were positive.

CONCLUSION: Quality improvement initiatives are needed to decrease the rate of inappropriate RADTs in pediatric UCC and ED settings.

Journal Title

Pediatric emergency care

Volume

38

Issue

1

First Page

231

Last Page

233

MeSH Keywords

Antigens, Bacterial; Child; Humans; Pharyngitis; Retrospective Studies; Sensitivity and Specificity; Streptococcal Infections; Streptococcus pyogenes

Keywords

Bacterial Antigens; Pharyngitis; Retrospective Studies; Sensitivity and Specificity; Streptococcal Infections; Streptococcus pyogenes

Recommended Citation

Linafelter A, Burns A, Lee BR, et al. Group A Streptococcal Pharyngitis Testing Appropriateness in Pediatric Acute Care Settings. Pediatr Emerg Care. 2022;38(1):e231-e233. doi:10.1097/PEC.0000000000002223