From the Division of Pharmacy, University of Missouri.
Division of Urgent Care.
Pediatr Emerg Care. 2022 Jan 1;38(1):e231-e233. doi: 10.1097/PEC.0000000000002223.
Acute pharyngitis is one of the most common causes of ambulatory clinic visits; however, group A Streptococcus accounts for less than a third. National guidelines recommend against streptococcal testing in patients with viral features. This study aims to assess the rate of inappropriate streptococcal rapid antigen detection tests (RADT)s in children evaluated in urgent care clinics (UCC)s and emergency department (ED)s at a children's hospital.
We retrospectively reviewed charts of 10% of children 3 years or older with RADTs ordered between April and September 2018 at EDs and UCCs. The test was determined to be inappropriate if the patient had no sore throat and/or had 2 or more viral symptoms: rhinorrhea/congestion, cough, diarrhea, hoarseness, conjunctivitis, or viral exanthem.
Over the study period, 7678 RADTs were performed, of which 7024 (91.2%) were in children 3 years or older. We evaluated 708 charts and found 44% of RADTs were inappropriate. The predicted probability of inappropriate RADT was highest among patients with a triaged reason for visit for respiratory complaints (70.5%), viral upper respiratory tract infection (69.7%), and rash (61.3%). Of the inappropriate RADTs, 20.1% were positive, whereas 32.2% of the appropriate RADTs were positive.
Quality improvement initiatives are needed to decrease the rate of inappropriate RADTs in pediatric UCC and ED settings.
急性咽炎是门急诊最常见的病因之一，但 A 组链球菌所致者不足三分之一。国家指南建议对具有病毒特征的患者不进行链球菌检测。本研究旨在评估在儿童医院急诊和门诊就诊的儿童中，不适当的 A 组链球菌快速抗原检测（RADT）的发生率。
我们回顾性分析了 2018 年 4 月至 9 月期间在急诊和门诊就诊的 3 岁及以上儿童进行的 10% RADT 检测的病历。如果患者无咽痛且/或具有 2 种或更多病毒症状（流涕/鼻塞、咳嗽、腹泻、声音嘶哑、结膜炎或病毒疹），则认为该检测为不适当。
在研究期间，共进行了 7678 次 RADT 检测，其中 7024 次（91.2%）在 3 岁及以上的儿童中进行。我们评估了 708 份病历，发现 44%的 RADT 为不适当。就诊原因分诊为呼吸道疾病（70.5%）、病毒性上呼吸道感染（69.7%）和皮疹（61.3%）的患者中，不适当 RADT 的预测概率最高。在不适当的 RADT 中，20.1%为阳性，而适当的 RADT 中，32.2%为阳性。
需要采取质量改进措施，以降低儿科急诊和门诊环境中不适当 RADT 的发生率。
