Should a near-patient test be part of the management of pharyngitis in the pediatric emergency department?

OBJECTIVE: The study's objective was to evaluate the efficacy of a rapid streptococcal test as a single diagnostic agent in the diagnosis of streptococcal pharyngitis in patients presenting to a pediatric emergency department.

METHODS: We performed a rapid streptococcal test as part of the diagnostic workup for patients presenting with clinical findings consistent with streptococcal pharyngitis. In addition to undergoing the study intervention, each patient had a standard throat swab sent to the laboratory for formal culture. A questionnaire detailing the clinical features was to be completed in each case.

RESULTS: Two hundred ten near-patient tests were performed. Complete laboratory results were available in 177 cases (77%). Clinical data were available for analysis in 94 patients (53%). In our patient population, the near-patient test had a high specificity (98.6%) but a low sensitivity (71%). The clinical presentation of confirmed group A β-hemolytic streptococcal pharyngitis is very variable.

CONCLUSIONS: The QuickVue In-Line Strep A test for streptococcal pharyngitis is unreliable in our patient population. Clinical findings are unhelpful in confirming the diagnosis. Formal laboratory culture is the criterion standard for identifying the organism, but the results are not clinically significant in every case. Acute pharyngitis presenting to the pediatric emergency department can be managed in accordance with the recommendations in the Scottish Intercollegiate Guideline Network guideline.