Rapid Antigen Group A Streptococcus Test to Diagnose Pharyngitis: A Systematic Review and Meta-Analysis
| Autor: | Brian P. Davis, Emily H. Stewart, Benjamin Littenberg, Carlos A. Estrada, B. Lee Clemans-Taylor, Robert M. Centor |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Bacterial Diseases
medicine.medical_specialty Pediatrics Streptococcus pyogenes Science MEDLINE Research and Analysis Methods medicine.disease_cause Sensitivity and Specificity Group A Chromatography Affinity Immunoenzyme Techniques Mathematical and Statistical Techniques Centre for Reviews and Dissemination Streptococcal Infections Internal medicine Medicine and Health Sciences medicine Humans Streptococcal Pharyngitis Statistical Methods Multidisciplinary medicine.diagnostic_test business.industry Streptococcus Pharyngitis Infectious Diseases Systematic review Meta-analysis Immunoassay Physical Sciences Medicine medicine.symptom business Mathematics Statistics (Mathematics) Research Article Meta-Analysis |
| Zdroj: | PLoS ONE, Vol 9, Iss 11, p e111727 (2014) PLoS ONE |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0111727 |
| Popis: | BackgroundPharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.ObjectiveTo examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.Data sourcesMEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000-2012.Study selectionCulture as reference standard, all languages.Data extraction and synthesisStudy characteristics, quality.Main outcome(s) and measure(s)Sensitivity, specificity.ResultsWe included 59 studies encompassing 55,766 patients. Forty three studies (18,464 patients) fulfilled the higher quality definition (at least 50 patients, prospective data collection, and no significant biases) and 16 (35,634 patients) did not. For the higher quality immunochromatographic methods in children (10,325 patients), heterogeneity was high for sensitivity (inconsistency [I(2)] 88%) and specificity (I(2) 86%). For enzyme immunoassay in children (342 patients), the pooled sensitivity was 86% (95% CI, 79-92%) and the pooled specificity was 92% (95% CI, 88-95%). For the higher quality immunochromatographic methods in the adult population (1,216 patients), the pooled sensitivity was 91% (95% CI, 87 to 94%) and the pooled specificity was 93% (95% CI, 92 to 95%); however, heterogeneity was modest for sensitivity (I(2) 61%) and specificity (I(2) 72%). For enzyme immunoassay in the adult population (333 patients), the pooled sensitivity was 86% (95% CI, 81-91%) and the pooled specificity was 97% (95% CI, 96 to 99%); however, heterogeneity was high for sensitivity and specificity (both, I(2) 88%).ConclusionsRAST immunochromatographic methods appear to be very sensitive and highly specific to diagnose group A streptococcal pharyngitis among adults but not in children. We could not identify sources of variability among higher quality studies. The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines. |
| Databáze: | OpenAIRE |
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