Daniels Rob, El Omda Tarek, Mokbel Kinan
Faculty of Health Care Professions, St Luke's Campus, University of Exeter, Exeter EX1 2LU, UK.
TASC Primary Care Network, Townsend House Medical Centre, Seaton EX12 2RY, UK.
Diagnostics (Basel). 2024 Nov 27;14(23):2680. doi: 10.3390/diagnostics14232680.
The diagnosis of streptococcal throat infection is an area where current practice results in significant over-diagnosis of bacterial infection, with the resulting implications for antimicrobial use and resistance. The use of molecular point of care testing (POCT) has previously been shown to alter antibiotic prescribing decisions when compared to Centor scoring. This paper explores the impact of the addition of POCT to clinical assessment using the McIsaac and FeverPAIN scoring systems. Retrospective analysis of the clinical records of 144 patients who had previously received point of care testing as part of a trial of POCT as an adjunct to usual care was undertaken. The McIsaac and FeverPAIN scores were calculated and then compared with the POCT result originally obtained. The records were also reviewed to identify further consultations within 10 days of being tested. Sufficient clinical data were available to calculate the FeverPAIN and McIsaac scores in 81% of patients and outcome data were available for 96.5% of patients. For patients with a FeverPAIN score of 4 or 5, 50-67% of patients had a positive POCT result, while for patients with a McIsaac score of 4 or 5, 50-68% had a positive POCT result. Moreover, 16.7% of patients who tested negative, and 16.3% of patients who tested positive, had a further consultation within 10 days of being assessed. Although relatively few patients in this study had maximum scores on the FeverPAIN and McIsaac scoring, the addition of POCT was shown to alter antibiotic prescribing decisions in a significant number of patients, supporting the use of Abbott ID NOW point of care testing to reduce antibiotic prescribing. Larger studies are required to confirm these results and explore the health economic aspects and potential impacts on health inequalities.
链球菌性咽喉感染的诊断领域中，当前的诊断实践导致细菌感染被大量过度诊断，这对抗菌药物的使用及耐药性产生了相应影响。与森托评分法相比，使用分子即时检验（POCT）此前已被证明会改变抗生素处方决策。本文探讨了将POCT添加到使用麦基萨克和发热疼痛评分系统的临床评估中的影响。对144例患者的临床记录进行了回顾性分析，这些患者之前作为POCT作为常规护理辅助手段的试验的一部分接受了即时检验。计算了麦基萨克和发热疼痛评分，然后与最初获得的POCT结果进行比较。还查阅了记录以确定检测后10天内的进一步会诊情况。81%的患者有足够的临床数据来计算发热疼痛和麦基萨克评分，96.5%的患者有结局数据。对于发热疼痛评分为4或5的患者，50 - 67%的患者POCT结果为阳性，而对于麦基萨克评分为4或5的患者，50 - 68%的患者POCT结果为阳性。此外，检测结果为阴性的患者中有16.7%，检测结果为阳性的患者中有16.3%在评估后10天内进行了进一步会诊。尽管本研究中相对较少的患者在发热疼痛和麦基萨克评分中获得最高分，但添加POCT被证明会在相当数量的患者中改变抗生素处方决策，这支持使用雅培ID NOW即时检验来减少抗生素处方。需要更大规模的研究来证实这些结果，并探讨其健康经济学方面以及对健康不平等的潜在影响。
