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The role of point of care testing for patients with acute pharyngitis
Steven J Atlas1, Steven M McDermott, Carol Mannone
1General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. satlas@partners.org
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 beta-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 > or =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.
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