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A clinical decision rule for streptococcal pharyngitis management: An update
Hosain Nasirian1, Saeedeh TarvijEslami1, Esfandiar Matini1
1Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran.
Insights
A clinical decision rule for Group A streptococcal (GAS) pharyngitis in children can accurately identify those unlikely to have the infection. This aids in avoiding unnecessary antibiotic use for suspected GAS pharyngitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Group A streptococcal (GAS) pharyngitis is a prevalent global infection.
- Accurate diagnosis is crucial for appropriate treatment and preventing complications.
Purpose of the Study:
- To develop a pragmatic clinical decision rule for diagnosing GAS pharyngitis in children.
- To assess the validity of clinical findings in predicting GAS infection.
Main Methods:
- A study involving 571 children aged 6-15 years with suspected GAS pharyngitis.
- Throat cultures were performed, and the accuracy of clinical findings (exudate, enlarged tender nodes) was evaluated.
Main Results:
- 99 patients (17.3%) had a positive GAS throat culture.
- Exudate and enlarged tender nodes showed moderate sensitivity but low specificity.
- The combination of exudate and enlarged nodes had 43.62% sensitivity and 57.19% specificity, with an 83% negative predictive value (NPV).
Conclusions:
- A high NPV of 83% suggests that in the absence of specific clinical signs, the likelihood of GAS pharyngitis is low.
- This clinical decision rule can help identify children unlikely to have GAS pharyngitis, potentially reducing unnecessary antibiotic prescriptions.
Purpose:
Group A streptococcal (GAS) pharyngitis is a common disease worldwide. We aimed to establish a pragmatic program as a clinical decision rule for GAS pharyngitis diagnosis.
Materials And Methods:
This article derived from a research project on children aged 6-15 years. Five hundred and seventy-one children met the enrollment criteria on whom throat culture and validities of clinical findings were assessed in positive and negative throat culture groups.
Results:
Positive GAS throat culture group included 99 (17.3%) patients with a positive culture. Negative GAS throat culture group included 472 (82.6%) patients. Exudate or enlarged tender nodes each one had 63% and 68% sensitivity and 31.5% and 37.5% specificity with a high percentage of negative predictive value (NPV) 80.54% and 85.09%, respectively. Sequence test revealed validities of exudate plus enlarged nodes at 43.62% sensitivity and 57.19% specificity with 83% NPV.
Conclusions:
High NPV of 83% indicated that similar prevalence in the absence of either exudate or enlarged tender lymph nodes. Probability of GAS negative throat cultures among children suspected of GAS pharyngitis was 83% and would correctly not receive inopportune antibiotics.