title: Point of care testing for group A streptococci in patients presenting with pharyngitis will improve appropriate antibiotic prescription.
abstract: OBJECTIVE
  History, clinical examination and throat culture may be inadequate to rule in or out the presence of group A streptococci (GAS) infection in patients with sore throat in a remote location. We correlated the diagnostic accuracy for guiding antibiotic prescription of clinical decision and physiological scoring systems to a rapid diagnostic point of care (POC) test result in paediatric patients presenting with sore throat.
  
  
  METHODS
  Prospective diagnostic accuracy study conducted between 30 June 2014 and 27 February 2015 in a remote Australian ED using a convenience sample. Among paediatric patients presenting with sore throat, the Centor criteria and clinical decision were documented. Simultaneously, patients without sore throat or respiratory tract infection were tested to determine the number of carriers. A throat swab on all patients was tested using a POC test (Alere TestPack +Plus Strep A with on board control), considered as reference standard to detect GAS infection.
  
  
  RESULTS
  A total of 101 patients with sore throat were tested with 26 (25.7%) positive for GAS. One hundred and forty-seven patients without sore throat were tested with one positive POC test result (specificity 99%; 95% CI 96-100). Positive predictive value for clinician decision-making for a positive GAS swab (bacterial infection) was 29% (95% CI 17-43), negative predictive value 78% (95% CI 63-88). Area under ROC for the Centor score was 0.70 (95% CI 0.58-0.81).
  
  
  CONCLUSIONS
  Clinician judgement and Centor score are inadequate tools for clinical decision-making for children presenting with sore throat. Adjunctive POC testing provides sufficient accuracy to guide antibiotic prescription on first presentation.
authors.affiliation: Emergency Department, Mount Isa Hospital, Mount Isa, Queensland, Australia.|Mount Isa Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Orda
authors.affiliation: Emergency Department, The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.affiliation: Emergency Department, Mount Isa Hospital, Mount Isa, Queensland, Australia.
authors.forename: Sabine
authors.initials: S
authors.lastname: Orda
authors.affiliation: Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.affiliation: Cairns Clinical School, James Cook University, Cairns, Queensland, Australia.
authors.forename: Ronny
authors.initials: R
authors.lastname: Gunnarsson
authors.affiliation: Emergency Department, Mount Isa Hospital, Mount Isa, Queensland, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: Rofe
authors.affiliation: Emergency Department, Mount Isa Hospital, Mount Isa, Queensland, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Dargan
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000032:analysis; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D010612:Pharyngitis / Q000175:diagnosis*; D000067716:Point-of-Care Testing / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011793:Queensland; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial
keywords: Centor score, clinical reasoning; accuracy of antibiotic prescribing; group A streptococci; pharyngitis; point of care testing