Streptococcal pharyngitis in the pediatric emergency department: value and impact of rapid antigen detection test

The French Health Agency (Afssaps) recommands the resort to the streptocoque rapid test strip for a better targetting of antibiotics prescription. To evaluate the systematic use of the test in a pediatric emergengy department. Comparison of results of the test to the laboratory cultures. Our study took place between January and December 2004. Two thousand one hundred (and) forty-four children with acute pharyngitis have been included (mean age: 4.8+/-3.6 years). Group A streptococcus was involved in 57 pharyngitis (26%). Mean age of children with positive culture was 7+/-3 years versus 4+/-3 years if culture was negative (p>0.05). The test sensitivity was 77% (CI 95%: 65-86) and its specificity 82% (CI 95%: 75-87), the positive predictive value was 60% (CI 95%: 49-71) and the negative predictive value 91% (CI 95%: 85-95). Antibiotic prescriptions have diminished: no prescription for 70% of pharyngitis and for 93% if cultures were negative. The rapid test strip wide use has a strong repercussion on the antibiotics prescription. This test is realist in pediatric emergency unit.