Streptococcal Pharyngitis: Compliance With National Testing Guidelines in a Pediatric Emergency Department.

Autor:	Thompson JM; From the Children's Minnesota Department of Pediatric Emergency Medicine., Zagel AL; Children's Minnesota Research Institute, Minneapolis, MN., Spaulding AB; Children's Minnesota Research Institute, Minneapolis, MN., Krause EA; Children's Minnesota Research Institute, Minneapolis, MN., Arms JL; From the Children's Minnesota Department of Pediatric Emergency Medicine.
Jazyk:	angličtina
Zdroj:	Pediatric emergency care [Pediatr Emerg Care] 2022 Feb 01; Vol. 38 (2), pp. e519-e523.
DOI:	10.1097/PEC.0000000000002512
Abstrakt:	Objectives: The Infectious Diseases Society of America (IDSA) guidelines regarding group A streptococcal (GAS) pharyngitis advise against routine testing for patients younger than 3 years, patients without pharyngitis, and patients with symptoms suggesting a viral infection. Group A streptococcal testing may be overused in some clinical settings; thus, we conducted this study to evaluate compliance with the IDSA guidelines in a pediatric emergency department (ED) setting. Methods: This retrospective cohort study describes patients younger than 18 years presenting to 2 urban pediatric EDs in 2016 who underwent rapid antigen detection testing for GAS pharyngitis. Testing was classified as noncompliant with the IDSA guidelines if the chief complaint was not indicative of GAS infection and/or the patient age was younger than 3 years. Appropriate nonparametric tests compared groups by IDSA testing compliance status. Results: A total of 13,585 patient encounters met inclusion criteria; 5255 (39%) were noncompliant with the IDSA testing guidelines, the majority due to a chief complaint inconsistent with GAS pharyngitis (67%) and secondarily due to the age of younger than 3 years (48%). Among the patients with noncompliant testing, 51% were prescribed an antibiotic, and return encounters were more likely to occur (13% vs 10%, P < 0.001). Return encounters more commonly resulted in respiratory diagnoses in those with noncompliant GAS testing (60% vs 45%, P < 0.001). Conclusions: Nearly 40% of all pediatric ED encounters with GAS testing were noncompliant with the IDSA guidelines and were associated with greater return encounter rates. Potential negative outcomes from noncompliant GAS testing include misdiagnosis, inappropriate use of antibiotics, allergic reactions, and loss of school days. Informed interventions to reduce unnecessary GAS testing are warranted. Competing Interests: Disclosure: The authors declare no conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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