Abstract

IMBERT TIBAUDIN, Denise; KILSTEIN, Jorge G.  and  QUAGLINO, Marta. Usefulness of clinical prediction criteria and rapid antigen detection testing for the management of acute pharyngitis in an emergency department. Rev Clin Med Fam [online]. 2016, vol.9, n.1, pp.23-30. ISSN 2386-8201.

Objective: To validate the modified CENTOR score (m-CENTOR) and the rapid antigen detection testing for group A streptococcus (GAS) in acute pharyngitis. Design: Diagnostic test validation study. Location and Participants: 101 eligible patients, who consulted at the emergency department in a third level Hospital with a clinical picture compatible with acute pharyngitis. Main measures: Pharyngeal swabs were obtained for culture and rapid antigen detection testing for group A Streptococcus (FAMR). CENTOR score was calculated for each case. Results: The average age of the patients included in the study was 22.6 years (SD: 13.8). The gender distribution was 48.5% males. The group A Streptococcus (GAS) was the pathogen isolated in the 20.79% of the cases. The m-CENTOR presented a sensibility of 83.3 %(50.9%-97.1%), specificity 45.5% (30.7%-61.0%), positive predictive value (PPV) of 29.4% (15.7%-47.7%) and negative predictive value (NPV) 90.9% (69.4%-98.4%). The FAMR presented a sensibility of 81.5% (61.3%-93.0%), specificity 98.6% (91.4%-99.9%) PPV 95.7% (76.0%-99.8%) and NPV 93.3% (84.5%-97.5%). 49.5% of the patients received antibiotics based on medical judgment, which resulted in a 62% increase in antimicrobial indication. Conclusions: The m-CENTOR score evidenced an accurate negative predictive value, and the FAMR presented good sensibility, specificity and positive predictive value for pharyngitis caused by GAS. The use of both methods in emergency care could optimize the management of the pathology and improve antibiotic adequacy.

Keywords : Pharyngitis; Streptococcus pyogenes; Diagnostic Tests; Routine.

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