Group A Streptococcal Pharyngitis Testing Appropriateness in Pediatric Acute Care Settings

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.