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Group A Streptococcal Pharyngitis Testing Appropriateness in Pediatric Acute Care Settings
Alaina Linafelter1, Alaina Burns1, Brian R Lee
1From the Division of Pharmacy, University of Missouri.
Insights
Nearly half of rapid antigen detection tests (RADTs) for strep throat in pediatric urgent care and emergency departments were inappropriately ordered. These tests are often given to children with viral symptoms, indicating a need for improved testing protocols.
Area of Science:
- Pediatric Medicine
- Infectious Diseases
- Clinical Quality Improvement
Background:
- Acute pharyngitis is a frequent reason for pediatric clinic visits.
- Group A Streptococcus causes less than one-third of these cases.
- National guidelines advise against testing for strep in patients with viral symptoms.
Purpose of the Study:
- To determine the rate of inappropriate rapid antigen detection tests (RADTs) for streptococcal pharyngitis.
- To evaluate testing practices in pediatric urgent care clinics (UCCs) and emergency departments (EDs).
Main Methods:
- Retrospective chart review of 10% of children aged 3+ who underwent RADTs.
- RADTs were deemed inappropriate if patients lacked a sore throat or had two or more viral symptoms.
- Data collected from April to September 2018 at a children's hospital.
Main Results:
- A total of 7678 RADTs were performed; 708 charts were reviewed.
- 44% of RADTs were found to be inappropriate.
- Inappropriate testing was most common for respiratory complaints (70.5%), viral upper respiratory tract infections (69.7%), and rash (61.3%).
Conclusions:
- A significant proportion of RADTs for streptococcal pharyngitis are inappropriately administered in pediatric UCC and ED settings.
- Quality improvement initiatives are necessary to reduce unnecessary testing.
- Optimizing RADT use can improve resource allocation and patient care.
Objective:
Acute pharyngitis is one of the most common causes of ambulatory clinic visits; however, group A Streptococcus accounts for less than a third. National guidelines recommend against streptococcal testing in patients with viral features. This study aims to assess the rate of inappropriate streptococcal rapid antigen detection tests (RADT)s in children evaluated in urgent care clinics (UCC)s and emergency department (ED)s at a children's hospital.
Methods:
We retrospectively reviewed charts of 10% of children 3 years or older with RADTs ordered between April and September 2018 at EDs and UCCs. The test was determined to be inappropriate if the patient had no sore throat and/or had 2 or more viral symptoms: rhinorrhea/congestion, cough, diarrhea, hoarseness, conjunctivitis, or viral exanthem.
Results:
Over the study period, 7678 RADTs were performed, of which 7024 (91.2%) were in children 3 years or older. We evaluated 708 charts and found 44% of RADTs were inappropriate. The predicted probability of inappropriate RADT was highest among patients with a triaged reason for visit for respiratory complaints (70.5%), viral upper respiratory tract infection (69.7%), and rash (61.3%). Of the inappropriate RADTs, 20.1% were positive, whereas 32.2% of the appropriate RADTs were positive.
Conclusion:
Quality improvement initiatives are needed to decrease the rate of inappropriate RADTs in pediatric UCC and ED settings.
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