Evaluating the American Academy of Pediatrics Diagnostic Standard for Streptococcus pyogenes Pharyngitis: Backup Culture Versus Repeat Rapid Antigen Testing
Objective. The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit. The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result.Methods. Two swabs were collected from children who were suspected of having S pyogenes pharyngitis. Each swab was used for a culture and an OSOM Ultra Strep A Test rapid antigen test. The gold standard of comparison was defined as the identification of S pyogenes on either of the 2 culture plates. Three diagnostic strategies were evaluated: a single rapid antigen test, a rapid antigen test with follow-up rapid antigen test (rapid-rapid), and a rapid antigen test with follow-up culture (rapid-culture).Results. A total of 210 (23.7%) of 887 throat cultures with matched data were identified with S pyogenes . A single rapid antigen test had a sensitivity of 87.6% (95% confidence interval [CI]: 83.2%–92.1%), the sensitivity of the rapid-rapid follow-up was 91.4% (95% CI: 87.6%–95.2%), and the sensitivity of the rapid-culture follow-up was 95.7% (95% CI: 93.0%–98.5%), which was significantly higher than the others. As shown in Fig [1][1], when these test strategies were evaluated on a subgroup with clinical symptoms commonly associated with S pyogenes pharyngitis, the sensitivities all increased and were no longer significantly different. None of the strategies reliably exceeded a 95% sensitivity threshold.Conclusions. The American Academy of Pediatrics strategy for S pyogenes detection in children with pharyngitis, requiring a backup culture for those with negative antigen tests, was not exceeded by any other test strategy; however, a rapid-rapid diagnostic strategy may approximate it with the use of judicious clinical selection of patients. [1]: #F1
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机译：目的。美国儿科学会建议，培养化脓性链球菌咽炎的所有阴性快速诊断测试都应通过培养来支持，这给临床医生带来了难题，因为他们在访问时必须做出治疗决定而没有完整的诊断信息。使用后续系列快速抗原检测代替后续培养将提供更及时的结果。从怀疑患有化脓性葡萄球菌性咽炎的儿童中收集了两个棉签。每个拭子用于培养和OSOM Ultra Strep A Test快速抗原测试。比较的金标准定义为在两个培养板中的任何一个上鉴定化脓性链球菌。评估了三种诊断策略：单次快速抗原检测，快速抗原检测和后续快速抗原检测（快速），以及快速抗原检测和后续培养（快速培养）。共有887个喉培养物中的210个（23.7％）具有匹配的化脓性细菌。单个快速抗原测试的敏感性为87.6％（95％置信区间[CI]：83.2％–92.1％），快速随访的敏感性为91.4％（95％CI：87.6％–95.2％） ），快速培养随访的敏感性为95.7％（95％CI：93.0％–98.5％），显着高于其他人。如图[1] [1]所示，当对具有通常与化脓性链球菌性咽炎相关的临床症状的亚组评估这些测试策略时，敏感性均增加并且不再有显着差异。没有一个策略能够可靠地超过95％的敏感度阈值。美国儿科学会针对咽炎患儿进行化脓性疾病检测的策略，要求对抗原检测阴性的人进行备用培养，其他任何检测策略均未超出该策略;但是，快速明智的诊断策略可以通过对患者进行明智的临床选择来近似。 [1]：＃F1
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