title: Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room.
abstract: OBJECTIVE
  To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children.
  
  
  METHODS
  This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis.
  
  
  RESULTS
  650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value.
  
  
  CONCLUSIONS
  The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.
authors.affiliation: Pronto-Socorro de Pediatria, Enfermaria de Pediatria, Hospital Universitário, USP, São Paulo, SP, Brasil.
authors.forename: Débora Morais
authors.initials: DM
authors.lastname: Cardoso
authors.forename: Alfredo Elias
authors.initials: AE
authors.lastname: Gilio
authors.forename: Shieh Huei
authors.initials: SH
authors.lastname: Hsin
authors.forename: Beatriz Marcondes
authors.initials: BM
authors.lastname: Machado
authors.forename: Milena
authors.initials: M
authors.lastname: de Paulis
authors.forename: João Paulo B
authors.initials: JP
authors.lastname: Lotufo
authors.forename: Marina Baquerizo
authors.initials: MB
authors.lastname: Martinez
authors.forename: Sandra Josefina E
authors.initials: SJ
authors.lastname: Grisi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D010612:Pharyngitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D011446:Prospective Studies; D012141:Respiratory Tract Infections; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000628:therapy*; D013297:Streptococcus pyogenes / Q000276:immunology*; D013997:Time Factors; D014069:Tonsillitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial