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Updated: Mar 7, 2026
Rapid Molecular Detection and Differentiation of Influenza Viruses A and B
Published on: January 30, 2017
Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective,
Jérémie F Cohen1,2,3, Robert Cohen4,5,6, Philippe Bidet7
1Department of General Pediatrics, Necker - Enfants malades hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France.
Background:
There is controversy whether physicians can rely on signs and symptoms to select children with pharyngitis who should undergo a rapid antigen detection test (RADT) for group A streptococcus (GAS). Our objective was to evaluate the efficiency of signs and symptoms in selectively testing children with pharyngitis.
Materials And Methods:
In this multicenter, prospective, cross-sectional study, French primary care physicians collected clinical data and double throat swabs from 676 consecutive children with pharyngitis; the first swab was used for the RADT and the second was used for a throat culture (reference standard). We developed a logistic regression model combining signs and symptoms with GAS as the outcome. We then derived a model-based selective testing strategy, assuming that children with low and high calculated probability of GAS (<0.12 and >0.85) would be managed without the RADT. Main outcomes and measures were performance of the model (c-index and calibration) and efficiency of the model-based strategy (proportion of participants in whom RADT could be avoided).
Results:
Throat culture was positive for GAS in 280 participants (41.4%). Out of 17 candidate signs and symptoms, eight were retained in the prediction model. The model had an optimism-corrected c-index of 0.73; calibration of the model was good. With the model-based strategy, RADT could be avoided in 6.6% of participants (95% confidence interval 4.7% to 8.5%), as compared to a RADT-for-all strategy.
Conclusions:
This study demonstrated that relying on signs and symptoms for selectively testing children with pharyngitis is not efficient. We recommend using a RADT in all children with pharyngitis.
