The role of point of care testing for patients with acute pharyngitis.
BACKGROUND
There is no consensus favoring a particular strategy for evaluating patients with pharyngitis.


OBJECTIVE
To compare a clinical decision aid and a rapid office-based point of care (POC) test with routine culture for group A beta-hemolytic streptococcus (GAS).


METHODS
Prospective observational study.


METHODS
Among 179 patients enrolled, 150 were eligible and 148 had POC testing and cultures initially performed.


METHODS
An encounter form included eligibility criteria, clinical information based upon the Centor rule, and treatment provided. Sensitivity and specificity of POC test compared to routine culture for GAS.


RESULTS
Thirty-eight patients (25.7%) had a positive GAS culture. The POC test was 92.1% sensitive (95% confidence interval [CI] 80% to 98%) and 100% specific (95% CI 97% to 100%). Although the Centor rule did not adequately discriminate among symptomatic patients with or without GAS (receiver operating curve area 0.63), the 3 patients with a false-negative POC test had a Centor score of less than 2. Among patients with a negative POC test, 26% initially received antibiotics.


CONCLUSIONS
For patients with a Centor score of > or =2, a POC test was highly sensitive for GAS. Future studies should confirm these results and assess whether implementation of POC testing as part of a local practice guideline can decrease variability in testing and treatment.
Atlas
Steven J
SJ
General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. satlas@partners.org
McDermott
Steven M
SM
Mannone
Carol
C
Barry
Michael J
MJ
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013297:Streptococcus pyogenes
D000900:Anti-Bacterial Agents