Pallon Jon, Hedin Katarina
Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.
Department of Research and Development, Region Kronoberg, Växjö, Sweden.
Scand J Prim Health Care. 2025 Mar;43(1):164-172. doi: 10.1080/02813432.2024.2416671. Epub 2024 Oct 25.
Point-of-care (POC) tests, including C-reactive protein (CRP) tests and rapid antigen detection tests (RADT) for group A streptococci (GAS), are widely used in Swedish primary health care (PHC). This study quantifies their use in pharyngotonsillitis and explore their association with antibiotic prescribing.
Retrospective data from 2012-2016 in Region Kronoberg, Sweden, included all PHC visits with a pharyngotonsillitis diagnosis. Patient characteristics, test usage and antibiotic prescriptions were linked by visit date and personal identification number. Descriptive statistics were used for POC test analysis. Logistic regression assessed the association between CRP levels and antibiotic prescribing.
Of 24,237 visits, 68% included RADT and 36% included a CRP test, with 89% of CRP tests performed alongside RADT. CRP testing was more frequent in patients with negative (56%) than positive RADTs (42%) ( < .001). Overall, 66% of RADTs were positive. Median CRP levels were 23 mg/l for positive RADT and 31 mg/l for negative RADT ( < .001). Antibiotics were prescribed for 95% of positive RADTs and 43% of negative RADTs ( < .001). In patients with negative RADTs, CRP testing was associated with higher antibiotic prescribing (57%) compared to no CRP testing (26%) ( < .001). Among these patients, CRP levels were associated with prescribing (aOR 1.032; 95% CI 1.029-1.035; < .001), with 50% of prescriptions occuring at CRP levels ≤ 20 mg/l.
The use of RADTs and the proportion of positive test were higher than expected, indicating inappropriate use and diagnostic bias. CRP testing, contrary to guidelines, was common and associated with increased antibiotic prescribing.
即时检验（POC），包括C反应蛋白（CRP）检测和A组链球菌（GAS）的快速抗原检测（RADT），在瑞典初级卫生保健（PHC）中广泛使用。本研究对其在咽喉扁桃体炎中的使用情况进行量化，并探讨其与抗生素处方的关联。
来自瑞典克鲁努贝里地区2012 - 2016年的回顾性数据，包括所有诊断为咽喉扁桃体炎的初级卫生保健就诊病例。患者特征、检测使用情况和抗生素处方通过就诊日期和个人识别号码进行关联。描述性统计用于即时检验分析。逻辑回归评估CRP水平与抗生素处方之间的关联。
在24237次就诊中，68%进行了RADT检测，36%进行了CRP检测，其中89%的CRP检测与RADT同时进行。RADT结果为阴性的患者中CRP检测更为频繁（56%），高于RADT结果为阳性的患者（42%）（P < 0.001）。总体而言，66%的RADT结果为阳性。RADT结果为阳性时CRP的中位数水平为23mg/l，RADT结果为阴性时为31mg/l（P < 0.001）。95%的RADT结果为阳性的患者以及43%的RADT结果为阴性的患者接受了抗生素处方（P < 0.001）。在RADT结果为阴性的患者中，与未进行CRP检测的患者（26%）相比，进行CRP检测的患者抗生素处方率更高（57%）（P < 0.001）。在这些患者中，CRP水平与处方开具相关（调整后比值比1.032；95%置信区间1.029 - 1.035；P < 0.001），50%的处方是在CRP水平≤20mg/l时开具的。
RADT的使用情况以及阳性检测比例高于预期，表明存在使用不当和诊断偏差。与指南相反，CRP检测很常见，且与抗生素处方增加有关。
