Wong M C K, Chung C H
Accident and Emergency Department, North District Hospital, Po Kin Road, Sheung Shui, Hong Kong.
Hong Kong Med J. 2002 Apr;8(2):92-8.
To determine the prevalence of group A streptococcal infection and to evaluate the predictive value of clinical findings and rapid streptococcal antigen detection testing in patients presenting with a sore throat or suspected clinically to have acute pharyngitis.
Prospective observational study.
Accident and emergency department of a public hospital, Hong Kong.
All patients presenting with a sore throat as the chief complaint, or suspected clinically to have acute pharyngitis, from April to September 2000.
Demographic data, clinical features, microbiological throat culture results, and rapid streptococcal antigen detection (Accustrip) test results.
Of 1449 patients recruited during the 6-month study period, only 44 (3.0%) had positive throat cultures for group A beta-haemolytic streptococcus. The majority of group A beta-haemolytic streptococci were isolated from patients between the age of 3 and 60 years. Clinical findings other than an absence of cough were found to be unhelpful in predicting group A beta-haemolytic streptococcal throat infection. The sensitivity of the rapid group A streptococcal antigen detection test was 52.6% and the specificity was 98.2%.
The prevalence of group A beta-haemolytic streptococcus in patients presenting with a sore throat, or suspected clinically of having acute pharyngitis, was low. If empirical antibiotics were given to all such patients, 97% of them would be unnecessarily treated. Age and absence of cough were the only clinical findings helpful in predicting the presence of group A beta-haemolytic streptococcal throat infection. The rapid group A streptococcal antigen detection test can provide a quick guide to clinicians on the necessity of antibiotic therapy. However, a confirmatory throat culture backup is recommended for patients with a negative test result.
确定A组链球菌感染的患病率，并评估临床症状及快速链球菌抗原检测试验对咽痛患者或临床疑似急性咽炎患者的预测价值。
前瞻性观察研究。
香港一家公立医院的急诊科。
2000年4月至9月期间，以咽痛为主诉或临床疑似急性咽炎的所有患者。
人口统计学数据、临床特征、咽喉部微生物培养结果以及快速链球菌抗原检测（Accustrip）试验结果。
在为期6个月的研究期间招募的1449例患者中，只有44例（3.0%）咽喉部培养出A组β溶血性链球菌阳性。大多数A组β溶血性链球菌分离自3至60岁的患者。除无咳嗽外，其他临床症状对预测A组β溶血性链球菌咽喉感染并无帮助。快速A组链球菌抗原检测试验的敏感性为52.6%，特异性为98.2%。
咽痛患者或临床疑似急性咽炎患者中A组β溶血性链球菌的患病率较低。若对所有此类患者均给予经验性抗生素治疗，其中97%的患者将接受不必要的治疗。年龄和无咳嗽是预测A组β溶血性链球菌咽喉感染的唯一有用临床症状。快速A组链球菌抗原检测试验可为临床医生提供抗生素治疗必要性的快速指导。然而，对于检测结果为阴性的患者，建议进行咽喉部培养以确诊。
