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Overview of 2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Group A
Miriam B Barshak1, Jeffrey A Linder2, Michael E Watson3
1Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Clinical scoring systems improve the diagnosis of group A streptococcal (GAS) pharyngitis. These systems offer comparable or better accuracy than clinician judgment alone for identifying GAS infections, aiding in appropriate testing decisions.
Area of Science:
- Infectious Diseases
- Clinical Practice Guidelines
- Diagnostic Accuracy
Background:
- Diagnosis of group A streptococcal (GAS) pharyngitis using clinical judgment alone is often unreliable.
- Universal testing for GAS pharyngitis can lead to unnecessary costs and inconvenience for low-risk individuals.
- Clinical scoring systems utilize standardized criteria to estimate the likelihood of a positive GAS throat culture.
Purpose of the Study:
- To review evidence on the utility of clinical scoring systems versus clinician judgment alone for diagnosing GAS pharyngitis.
- To provide a recommendation on whether scoring systems should guide GAS diagnostic testing.
- To inform updates to clinical practice guidelines for GAS pharyngitis management.
Main Methods:
- Systematic review of randomized and non-randomized studies.
- Comparison of diagnostic accuracy between clinical scoring systems and clinician judgment alone.
- Evaluation of studies in both pediatric and adult populations.
Main Results:
- Evidence suggests comparable or slightly higher diagnostic accuracy when using a clinical scoring system compared to clinician judgment alone.
- Studies, though limited by size and data uniformity, indicate potential benefits of scoring systems.
- The panel consensus favors incorporating scoring systems into the evaluation of suspected GAS pharyngitis.
Conclusions:
- Clinical scoring systems are a valuable tool in the evaluation of patients with suspected GAS pharyngitis.
- Incorporating scoring systems can help optimize the use of diagnostic tests like rapid antigen detection tests (RADTs), molecular methods, and throat cultures.
- This evidence supports the updated clinical practice guideline recommendations for GAS pharyngitis diagnosis and management.
Abstract:
This publication represents the first part of an update to the clinical practice guideline on the diagnosis and management of group A streptococcal (GAS) pharyngitis, developed by the Infectious Diseases Society of America (IDSA). Diagnosis of GAS pharyngitis by clinician judgment alone is unreliable, and universal testing incurs cost and inconvenience for individuals at low risk of having GAS infection. Clinical scoring systems have been used to quantify the probability of a positive GAS throat culture based on standardized criteria such as the presence of fever, tonsillar enlargement or exudate, tender and enlarged anterior cervical lymph nodes, and the absence of cough. The goal of this manuscript is to review the evidence and provide a recommendation as to whether a scoring system should be used to decide which patients should have a GAS diagnostic test (ie, rapid antigen test [RADT], molecular method, and/or throat culture) performed. We performed a systematic review of randomized and nonrandomized studies that compared the use of a clinical scoring system to clinician judgment alone in predicting the result of a throat culture. Evidence from studies in children and adults suggests the diagnostic accuracy is comparable or slightly higher using a scoring system compared to clinician judgment alone. Although the studies are limited due to small size, lack of uniformity in outcome measures, and incomplete data, the consensus of the panel is that the balance of benefits and harms favors incorporation of a clinical scoring system as part of the evaluation of patients with sore throat and suspected GAS pharyngitis.
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