The Role of Point of Care Testing for Patients with Acute Pharyngitis

Authors

  • Steven J. Atlas MD, MPH,

    1. From the General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA.
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  • Steven M. McDermott RN,

    1. From the General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA.
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  • Carol Mannone RN,

    1. From the General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA.
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  • Michael J. Barry MD

    1. From the General Medicine Division, Medical Services, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114, USA.
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  • Dr. Atlas has performed consulting for Aventis-Sanofi Pharmaceuticals for unrelated work.

  • This work was presented in part at a New England Regional meeting of the Society of General Internal Medicine, Boston, Mass, on March 5, 2004.

Address correspondence and reprint requests to Dr. Atlas: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 (e-mail: satlas@partners.org).

Abstract

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 β-hemolytic streptococcus (GAS).

Design: Prospective observational study.

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

Measurements: 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 ≥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.

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