Rapid antigen detection test for group A streptococcus in children with pharyngitis

Area of Science:

• Pediatric Infectious Diseases
• Diagnostic Accuracy Studies
• Microbiology

Background:

• Group A Streptococcus (GAS) causes 20-40% of childhood pharyngitis.
• Rapid antigen detection tests (RADTs) provide point-of-care diagnosis for pharyngitis within minutes.
• RADTs offer a faster alternative to traditional throat cultures.

Purpose of the Study:

• To evaluate the diagnostic accuracy of RADTs for GAS pharyngitis in children.
• To compare the diagnostic accuracy of enzyme immunoassays (EIA) and optical immunoassays (OIA) RADTs.

Main Methods:

• Systematic review and bivariate meta-analysis of 98 studies (116 test evaluations).
• Included studies compared RADTs with throat culture in ambulatory pediatric care.
• QUADAS-2 tool used for quality assessment; data extracted by two independent reviewers.

Main Results:

• Overall RADT sensitivity was 85.6% (95% CI 83.3-87.6) and specificity was 95.4% (95% CI 94.5-96.2).
• Methodological quality was generally poor, with high risk of bias in patient selection and reference standards.
• EIA and OIA tests demonstrated comparable sensitivity (85.4% vs. 86.2%).

Conclusions:

• RADTs have high specificity, reducing unnecessary antibiotic use.
• Approximately 14% of GAS cases may be missed with RADTs, necessitating consideration of epidemiological context.
• RADT performance is stable in studies with low risk of bias.