Does near-to-patient testing contribute to the diagnosis of streptococcal pharyngitis in adults?
OBJECTIVE
To asses the efficacy of near-to-patient laboratory testing in diagnosing group A beta haemolytic streptococci throat infection in adults, alone and in conjunction with the doctor's clinical judgement.


METHODS
174 primary care patients with a sore throat, of which 59 (34%) were identified as having group A streptococci.


METHODS
The erythrocyte sedimentation rate, leucocyte count, and C-reactive protein, and a specific streptococcal immunological assay were evaluated separately and in conjunction with the doctor's clinical diagnosis. The presence of GAS throat infection, the reference standard, was defined as those patients presenting with a chief complaint of sore throat and having a positive GAS culture or a four-fold or more increase or fall of AST or ADNase B serum levels during a four-week observation period.


RESULTS
The discriminatory ability of the sedimentation rate was not satisfactory and added little useful clinical information. Leucocytes and C-reactive protein both yielded clinically significant information and had similar test characteristics. The immunological test had the best characteristics of the tests evaluated.


CONCLUSIONS
Near-to-patient testing, except the erythrocyte sedimentation rate, may, in addition to the clinical evaluation, contribute to the differential diagnosis of streptococcal pharyngitis in adults.
Department of General Practice, University of Oslo, Norway.
P
P
Hjortdahl
H
H
Melbye
D000293:Adolescent; D000328:Adult; D000368:Aged; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D010612:Pharyngitis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D010808:Physical Examination; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections; D013297:Streptococcus pyogenes
D002097:C-Reactive Protein