From the Emergency Department, John Radcliffe Hospital, Oxford.
Public Health England Midlands and East Region.
Pediatr Emerg Care. 2021 May 1;37(5):e249-e251. doi: 10.1097/PEC.0000000000001560.
Sore throat is a common presentation to the children's emergency department (ED), and many patients are likely prescribed antibiotics unnecessarily. We aimed to reduce antibiotic prescribing for sore throat in our UK ED through use of an established scoring system combined with a rapid diagnostic test (RDT) to detect group A streptococcal (GAS) pharyngitis.
AB single-subject and diagnostic accuracy studies were used to measure both antibiotic prescribing rates over time and the performance of the McIsaac clinical score combined with RDT to screen for and treat GAS pharyngitis. All children between the age of 6 months and 16 years with symptoms of sore throat were eligible for inclusion. The study adhered to SQUIRE guidelines.
During 2014 and 2016, antibiotic prescribing rates for 210 children at baseline (median age, 3 years) and 395 children during the intervention (median age, 2 years) were assessed. The baseline prescribing rate was 79%, whereas rates after intervention were 24% and 27%, respectively. The RDT had an acceptable false-negative rate of 7.9%, poor sensitivity of 64.3%, and a negative predictive value of 92.1% when compared with conventional throat culture. A McIsaac score of 3 or more had good sensitivity (92.11%) but very low specificity (12.62%) for predicting GAS infection.
Despite poor RDT sensitivity and the McIsaac score's poor specificity in children, their use in combination decreased antibiotic prescribing rates in a children's ED setting.
喉咙痛是儿童急诊科（ED）常见的就诊症状，许多患者可能不必要地开具抗生素。我们旨在通过使用已建立的评分系统结合快速诊断测试（RDT）来检测 A 组链球菌（GAS）咽炎，从而减少我们英国 ED 中喉咙痛患者开具抗生素的情况。
采用 AB 单病例和诊断准确性研究来衡量随时间推移的抗生素开具率，以及 McIsaac 临床评分与 RDT 相结合用于筛查和治疗 GAS 咽炎的性能。所有年龄在 6 个月至 16 岁之间、有喉咙痛症状的儿童均有资格入选。该研究符合 SQUIRE 指南。
在 2014 年和 2016 年，对 210 名基线（中位年龄为 3 岁）和 395 名干预（中位年龄为 2 岁）儿童进行了抗生素开具率评估。基线开具率为 79%，而干预后的开具率分别为 24%和 27%。与常规咽拭子培养相比，RDT 的假阴性率为 7.9%，敏感性较差（64.3%），阴性预测值为 92.1%。McIsaac 评分≥3 分对预测 GAS 感染具有较高的敏感性（92.11%），但特异性（12.62%）较低。
尽管 RDT 的敏感性和 McIsaac 评分的特异性较差，但在儿童中联合使用这两种方法可以降低儿童急诊科的抗生素开具率。
