title: Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice.
abstract: BACKGROUND
  Sore throat is a common complaint in general practice. However, management strategies are not very clear. A better diagnostic procedure is needed to prevent the overuse of antibiotics.
  
  
  OBJECTIVE
  To assess the diagnostic value of a rapid streptococcal antigen detection test in addition to four clinical features in patients with sore throat, using throat culture and antibody titres as reference tests.
  
  
  METHODS
  Four clinical features [fever (history) > or = 38.0 degrees C, lack of cough, tonsillar exudate, and anterior cervical lymphadenopathy] were registered in 558 patients aged 4 to 60 years presenting with sore throat of no more than 14 days' duration. A rapid diagnostic test was performed, as well as a throat culture and antibody titres [fourfold increase in anti-streptolysin-O (ASO) and/or anti-deoxyribonuclease B (anti-DNAase B)] in patients aged 11 years and older.
  
  
  RESULTS
  Throat cultures were positive for group A beta-haemolytic streptococcus (GABHS) in 33% of the patients. Rapid tests were positive in 24%. Compared with the throat culture, the sensitivity of the rapid test was 65%, the specificity 96%, the positive predictive value 88%, and the negative predictive value 85%. However, for patients with three or four clinical features, the sensitivity of the rapid test was considerably higher at 75%. Children (< or = 14 years) had a slightly raised specificity and raised positive predictive value and prevalence. With the antibody titres as a reference, the rapid test performed as well as the throat culture with regard to its predictive value.
  
  
  CONCLUSIONS
  For the management of patients with sore throat in general practice, a rapid test may have an additional value, especially in patients with a high chance of having GABHS infection. However, as the sensitivity of the test studied is low, tests with a higher sensitivity are needed.
authors.affiliation: Department of General Practice, University of Utrecht, The Netherlands.
authors.forename: C F
authors.initials: CF
authors.lastname: Dagnelie
authors.forename: M L
authors.initials: ML
authors.lastname: Bartelink
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: W
authors.initials: W
authors.lastname: Goessens
authors.forename: R A
authors.initials: RA
authors.lastname: de Melker
mesh_terms: D000293:Adolescent; D000328:Adult; D000942:Antigens, Bacterial / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis* / Q000382:microbiology; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000276:immunology / Q000302:isolation & purification; D006113:United Kingdom
chemical_list: D000942:Antigens, Bacterial