Abstract
BACKGROUND: There is no consensus favoring a particular strategy for evaluating patients with pharyngitis.
OBJECTIVE: To compare a clinical decision aid and a rapid office-based point of care (POC) test with routine culture for group A β-hemolytic streptococcus (GAS).
DESIGN: Prospective observational study.
PARTICIPANTS: Among 179 patients enrolled, 150 were eligible and 148 had POC testing and cultures initially performed.
MEASUREMENTS: An encounter form included eligibility criteria, clinical information based upon the Centor rule, and treatment provided. Sensitivity and specificity of POC test compared to routine culture for GAS.
RESULTS: Thirty-eight patients (25.7%) had a positive GAS culture. The POC test was 92.1% sensitive (95% confidence interval [CI] 80% to 98%) and 100% specific (95% CI 97% to 100%). Although the Centor rule did not adequately discriminate among symptomatic patients with or without GAS (receiver operating curve area 0.63), the 3 patients with a false-negative POC test had a Centor score of less than 2. Among patients with a negative POC test, 26% initially received antibiotics.
CONCLUSIONS: For patients with a Centor score of ≥2, a POC test was highly sensitive for GAS. Future studies should confirm these results and assess whether implementation of POC testing as part of a local practice guideline can decrease variability in testing and treatment.
Similar content being viewed by others
References
Steinman MA, Gonzales R, Linder JA, Landefeld CS. Changing use of antibiotics in community-based outpatient practice, 1991–1999. Ann Intern Med. 2003;138:525–33.
Bisno AL. Acute pharyngitis. N Engl J Med. 2001;244:205–11.
Cooper RJ, Hoffman JR, Bartlett JG, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Intern Med. 2001;134:509–17.
Brink WR, Rammelkamp CH Jr., Denny FW, Wannamaker LW. Effect of penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis. Am J Med. 1951;10:300–8.
Zwart S, Sachs A, Ruijs G, et al. Penicillin for acute sore throat: randomized double blind trial of seven days versus three days treatment or placebo in adults. BMJ. 2000;320:150–4.
Neuner JM, Hamel MB, Phillips RS, et al. Diagnosis and management of adults with pharyngitis. A cost-effectiveness analysis. Ann Intern Med. 2003;139:113–22.
Webb KH, Needham CA, Kurtz SR. Use of high-sensitivity rapid strept test without culture confirmation of negative results: 2 years’ experience. J Fam Pract. 2000;49:24–8.
Bisno AL. Group A streptococcal infections and acute rheumatic fever. N Engl J Med. 1991;325:783–93.
Snellman L, Stang H, Stand J, et al. Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy. Pediatrics. 1993;96:758–64.
Ebell MH, Smith MA, Barry HC Ives K, Carey M. Does this patient have strept throat? JAMA. 2000;284:2912–8.
McIssac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004;291:1587–95.
Wegner DL, Witte DL, Schrantz RD. Insensitivity of rapid antigen detection methods and single blood agar plate culture for diagnosing streptococcal pharyngitis. JAMA. 1992;267:695–7.
Bisno AL, Peter GS, Kaplan EL. Diagnosis of strept throat in adults: are clinical criteria really good enough? Clin Infect Dis. 2002;35:126–9.
Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strept throat in adults in the emergency room. Med Decis Making. 1981;1:239–46.
Bisno AL, Gerber MA, Gwaltney JM Jr., Kaplan EL, Schwartz RH. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis. 2002;35:113–25.
Little P, Williamson I, Warner G, Gould C, Gantley M, Kinmonth AL. Open randomized trial of prescribing strategies in managing sore throat. BMJ. 1997;314:722–7.
Halm EA, Atlas SJ, Borowsky LH, et al. Understanding physician adherence with a pneumonia practice guideline: effects of patient, system, and physician factors. Arch Intern Med. 2000;160:98–104.
Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL. Clinical and psychosocial predictors of illness duration from randomized controlled trial of prescribing strategies for sore throat. BMJ. 1999;319:736–7.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Atlas has performed consulting for Aventis-Sanofi Pharmaceuticals for unrelated work.
This work was supported by institutional funding through the Massachusetts General Hospital Primary Care Operations Improvement program.
Rights and permissions
About this article
Cite this article
Atlas, S.J., McDermott, S.M., Mannone, C. et al. Brief report: The role of point of care testing for patients with acute pharyngitis. J Gen Intern Med 20, 759–761 (2005). https://doi.org/10.1111/j.1525-1497.2005.0143.x
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2005.0143.x