目的:美国传染病学会(IDSA)关于A组链球菌(GAS)咽炎的指南建议不要对3岁以下的患者进行常规检查,没有咽炎的患者,和症状提示病毒感染的患者。A组链球菌测试可能在某些临床环境中被过度使用;因此,我们进行这项研究是为了评估儿科急诊科(ED)患者对IDSA指南的依从性.
方法:这项回顾性队列研究描述了2016年出现2例城市儿科ED的18岁以下患者,这些患者接受了快速抗原检测以检测GAS咽炎。如果主诉不提示GAS感染和/或患者年龄小于3岁,则测试被归类为不符合IDSA指南。适当的非参数检验按IDSA测试合规性状态比较组。
结果:共有13,585例患者符合纳入标准;5255例(39%)不符合IDSA测试指南,大多数是由于主诉与GAS咽炎不一致(67%),其次是由于年龄小于3岁(48%)。在测试不合规的患者中,51%的人被开了抗生素,和返回相遇更有可能发生(13%对10%,P<0.001)。在那些不符合GAS测试的患者中,返回遭遇更常见的导致呼吸道诊断(60%对45%,P<0.001)。
结论:在所有接受GAS检测的儿科ED患者中,近40%不符合IDSA指南,并且与更高的复诊率相关。不符合GAS检测的潜在负面结果包括误诊,抗生素的不当使用,过敏反应,失去上学的日子。有必要采取知情干预措施以减少不必要的GAS测试。
OBJECTIVE: 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.