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Molecular Point-of-Care Testing in the Emergency Department for Group A Streptococcus Pharyngitis : A Randomized
Carson Gill1, Clement Chui1, David M Goldfarb
1From the Departments of Pediatrics.
Insights
Rapid molecular testing for group A Streptococcus (GAS) pharyngitis in pediatric emergency departments led to earlier antibiotic treatment and fewer prescriptions. However, this did not improve clinical outcomes like fever resolution.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Diagnostic Testing
Background:
- Group A Streptococcus (GAS) pharyngitis is a common pediatric illness.
- Accurate and timely diagnosis is crucial for appropriate management and preventing complications.
- Traditional throat culture has limitations in speed compared to molecular methods.
Purpose of the Study:
- To compare clinical and health systems outcomes of rapid molecular testing versus throat culture for GAS pharyngitis in a pediatric emergency department.
- Evaluate the impact of point-of-care (POC) nucleic acid amplification testing (NAAT) on patient management and resource utilization.
Main Methods:
- A single-center randomized trial involving children aged 3-17 with suspected GAS pharyngitis.
- Participants were randomized to either POC NAAT or standard throat culture.
- Primary outcome was time to resolution of throat pain and fever; secondary outcomes included absenteeism and antibiotic use.
Main Results:
- Earlier antibiotic initiation by approximately 1 day in the POC NAAT group.
- Significantly lower proportion of prescribed antibiotics in the POC group (35%) compared to the culture group (79%).
- No significant difference observed in time to symptom resolution between the two groups.
Conclusions:
- POC NAAT for GAS pharyngitis in a pediatric emergency department enables earlier treatment initiation and reduces antibiotic prescriptions.
- While not improving clinical outcomes in this study, POC NAAT is a valuable tool given evolving febrile illnesses and antimicrobial resistance.
- The study highlights the potential of rapid diagnostics in optimizing antibiotic stewardship in pediatric care.
Objectives:
To compare clinical and health systems outcomes of rapid molecular testing versus throat culture recovery for the management of group A Streptococcus (GAS) pharyngitis in a pediatric emergency department (PED).
Methods:
We conducted a single-center randomized trial of children (3-17 years) presenting to a PED with suspected GAS pharyngitis. A single dual-headed throat swab was collected, and participants were randomized to 1 of 2 parallel treatment groups with 1:1 allocation: point-of-care (POC) nucleic acid amplification testing or standard throat culture. The primary outcomes were time to throat pain +/- fever resolution. Secondary outcomes included absenteeism, length of stay, return visits to care, and antibiotic prescriptions and utilization.
Results:
A total of 227 children were randomly assigned to culture (n = 115) or POC (n = 112) testing. Antibiotics were initiated earlier in the POC group by approximately 1 day (95% confidence interval, -0.40 to -1.58). No associated difference in time to throat pain or fever resolution was observed between groups. There was a decrease in the proportion of prescribed antibiotics in the POC group (0.35) compared with the culture group (0.79; P < 0.001). Otherwise, no significant differences in secondary outcomes were observed.
Conclusions:
Establishing a POC nucleic acid amplification testing program for GAS in a PED facilitates earlier treatment and fewer antibiotic prescriptions. Although this did not translate to improved clinical and health systems outcomes in our study, it may serve as an important tool amid evolving pediatric febrile illnesses and growing antimicrobial resistance patterns.
