scholarly journals Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study

10.2196/25899 ◽  
2021 ◽  
Vol 23 (12) ◽  
pp. e25899
Author(s):  
Jennifer L Pecina ◽  
Leah M Nigon ◽  
Kristine S Penza ◽  
Martha A Murray ◽  
Beckie J Kronebusch ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Observational Study ◽  
Sore Throat ◽  
Scoring System ◽  
Group A Streptococcus ◽  
Streptococcal Pharyngitis ◽  
Future Studies ◽  
Face To Face ◽  
Geographic Barriers ◽  
Group A

Background The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

scholarly journals Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study (Preprint)

2020 ◽  
Author(s):  
Jennifer L Pecina ◽  
Leah M Nigon ◽  
Kristine S Penza ◽  
Martha A Murray ◽  
Beckie J Kronebusch ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Observational Study ◽  
Sore Throat ◽  
Scoring System ◽  
Group A Streptococcus ◽  
Streptococcal Pharyngitis ◽  
Future Studies ◽  
Face To Face ◽  
Geographic Barriers ◽  
Group A

BACKGROUND The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. OBJECTIVE We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. METHODS This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. RESULTS There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. CONCLUSIONS McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

McIsaac score for group A streptococcal infection: Comparison of electronic visits versus face-to-face visits

2021 ◽  
pp. 1357633X2199099
Author(s):  
Nathaniel E Miller ◽  
Teresa B Jensen ◽  
Leah M Nigon ◽  
Kristine S Penza ◽  
Martha A Murray ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Physical Examination ◽  
Sore Throat ◽  
Streptococcal Infection ◽  
Patient Portal ◽  
Face To Face ◽  
Common Complaint ◽  
Moderate Agreement ◽  
Group A ◽  
Kappa Agreement

Introduction Acute sore throat is a common complaint traditionally completed with an in-person visit. However, non-face-to-face telemedicine visits offer greater access at reduced cost. We evaluated patient/caregiver asynchronous text-based electronic visits (eVisits) for acute sore throat and whether there was concordance for individual components and total McIsaac score compared to a clinician’s assessment. eVisits were completed by patients and/or their caregivers via a secure patient portal. Methods In this retrospective study, we manually reviewed charts between February 2017 and July 2019 of patients who had an eVisit, in-person visit and group A streptococcal (GAS) test performed on the same day for an acute sore throat. We calculated a McIsaac score for eVisits and in-person visits, and compared each component and total score using Cohen’s kappa agreement statistic. Results There were 320 instances of patients who had an eVisit, in-person visit and GAS testing done on the same day. Approximately a third of eVisits were missing at least one McIsaac component, with the physical examination elements missing most commonly. Individual score congruence was moderate for cough (0.41), fair for fever (0.34) and slight for tonsillar swelling/exudate and lymphadenopathy (0.17 and 0.08, respectively), with total congruence being slight to fair (0.09–0.37). A McIsaac score of ≤1 showed moderate agreement (0.44). Visits with complete individual score components demonstrated improved congruence: substantial for cough (0.64), moderate for fever (0.57), fair for tonsillar swelling (0.3) and slight for lymphadenopathy (0.13). Discussion Overall agreement for individual score components was better for symptoms than it was for examination components, and was improved when data were complete. A McIsaac score of 1 or 0 had moderate agreement and thus could reasonably be safely used to exclude patients from GAS testing.

Should Routine Throat Cultures Be Done in Hospital Personnel Complaining of a Sore Throat?

1985 ◽  
Vol 6 (5) ◽  
pp. 183-185 ◽  
Author(s):  
Chatrchai Watanakunakorn
Keyword(s):  
Sore Throat ◽  
Teaching Hospital ◽  
High Probability ◽  
Group A Streptococcus ◽  
Streptococcal Pharyngitis ◽  
Adult Patients ◽  
Hospital Personnel ◽  
Group A ◽  
Community Teaching

AbstractIn a 750-bed community-teaching hospital with 3,200 employees, throat cultures were routinely done in hospital personnel complaining of a sore throat. During a 3-month period, 323 employees had throat cultures; only 20 (6.2%) of these throat cultures grew group A streptococcus. The prevalence of positive throat cultures was similarly low in employees (6.2%) and adult patients (7.3%). There was no evidence that employees either had higher prevalence of group A streptococcal pharyngitis or that they spread the infection to patients. It is concluded that routine throat cultures are not warranted in employees complaining of a sore throat, and that throat cultures should be done only selectively in hospital personnel with a high probability of group A streptococcal pharyngitis.

Antibiotic Susceptibility Evaluation of Bacterial Agents Causing Infection in Children with Acute Tonsillopharyngitis

2020 ◽  
Vol 20 ◽  
Author(s):  
Hamidreza Sherkatolabbasieh ◽  
Majid Firouzi ◽  
Shiva Shafizadeh ◽  
Iman Amiri
Keyword(s):  
Sore Throat ◽  
Predictive Value ◽  
Positive Culture ◽  
Clinical Score ◽  
Streptococcal Pharyngitis ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Cross Sectional ◽  
Clinical Sensitivity ◽  
Group A

Background: The aim of this study is to evaluate the prevalence of group A beta-hemolytic pharyngitis by assessing the outcome of the culture and the resistance and sensitivity of group A beta hemolytic streptococcus to antibiotics. Methods: This cross-sectional study was conducted on 170 patients, aged 3-15 years, referred to the clinic with complaints of sore throat. Patients’ history was collected and physical examination was performed and were score based on clinical findings. Patients with other underlying pathologies and those taking antibiotics prior to the study were excluded from our study. Antimicrobial susceptibility test was performed by disk diffusion method against cephalexin, cefazolin, erythromycin and amoxicillin. Results: A total of 170 patients were reported with sore throat. Patients with positive culture results were 60% male and 40% female. Amoxicillin resistance was the greatest (5%) in the culture. All isolated bacteria were sensitive to amoxicillin, cephalexin, cefazolin and erythromycin. Patients with McIssac score ≥ 6 showed clinical sensitivity 75% specificity 61% negative predictive value 94.8% and positive predictive value 20.3% for Group A beta-hemolytic streptococcal pharyngitis. Conclusion: The results showed the higher the clinical score, the greater the chance of positive throat culture.

scholarly journals Streptococcal pharyngitis in general practice. 1. Some unusual features of the epidemiology

1992 ◽  
Vol 109 (2) ◽  
pp. 181-189 ◽  
Author(s):  
P. M. Higgins
Keyword(s):  
Sore Throat ◽  
Age Distribution ◽  
Positive Culture ◽  
Streptococcal Pharyngitis ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Acute Infections ◽  
Group A ◽  
Upper Respiratory ◽  
Highly Correlated

SUMMARYThis report is based on a study of acute infections of the upper respiratory tract in 1965 and detailed records of such infections in 1963 and 1964. A change from illnesses mainly yielding viruses to illnesses mainly yielding group A streptococci was noted around the age of 5 years. A positive culture for group A streptococci in patients over 4 years of age was highly correlated with a complaint of sore throat and with serological evidence of streptococcal infection. A bimodal age distribution curve for pharyngitis associated with a positive culture for group A streptococci was consistently noted. The incidence was highest in children aged 5–9 but a second smaller peak occurred among adults in the 30–39 age group. The evidence suggests that being female increases the risk of acquiring group A streptococci and of experiencing sore throat.

scholarly journals Value of rapid test for identification of beta hemolytic Streptococcus antigens in children with Streptococcal pharyngitis

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 39-41 ◽  
Author(s):  
Branimir Nestorovic ◽  
Suzana Laban-Nestorovic ◽  
Veselinka Paripovic ◽  
Katarina Milosevic
Keyword(s):  
Group A Streptococcus ◽  
Rapid Test ◽  
Streptococcal Pharyngitis ◽  
Early Spring ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Isolation And Identification ◽  
Cervical Lymph Nodes ◽  
Group A ◽  
Tract Infections

Beta-hemolytic group A streptococcus (Streptococcus pyogenes) is the most common bacterial agent associated with the upper respiratory tract infections in humans. The most frequently group A streptococcus-associated disease is pharyngitis. Males and females are equally affected by group A streptococcus. There is seasonal increase in the prevalence of group A streptococcus-associated pharyngitis. Streptococcal pharyngitis is most prevalent in winter and early spring with higher incidence of disease observed in crowded population such as school children. Early diagnosis and treatment of group A streptococcal pharyngitis has been shown to reduce the severity of symptoms and further complications such as rheumatic fever and glomerulonephritis. The conventional methods used for identification of group A streptococci depend on isolation and identification of the organism on blood agar plates. These methods usually require 18-24 hours of incubation at 37?C. Such delay in identifying the group A streptococcus has often made physicians to administer therapy without first disclosing the etiological agent. Development of immunologic tests, capable of detecting the group A streptococcal antigen directly from the throat swabs, produced rapid test results employed for better treatment of patients. STREP A test is a rapid immunochromatographic test for the detection of group A streptococci from throat swabs or culture. The accuracy of the test does not depend on the organism viability. Instead, group A strep antigen is extracted directly from the swab and identified using antibodies specific for the group A carbohydrates. We compared rapid test with conventional throat swab in 40 children, who met Centor criteria for streptococcal pharyngitis (absence of cough, high fever, purulent pharyngitis, enlarged and painful cervical lymph nodes). Overall congruence of rapid test and culture was 94%. Test is easy to perform and it is recommended as the first diagnostic test for management of children with streptococcal pharyngitis. In children with negative test, but with characteristics highly suggestive of streptococcal infection, throat culture should be performed.

scholarly journals Molecular Testing for Detection of Groups A, C, and G β-Hemolytic Streptococci in Pharyngeal Samples from Children

2018 ◽  
Vol 3 (3) ◽  
pp. 429-437 ◽  
Author(s):  
Tam T Van ◽  
Javier Mestas ◽  
Jennifer Dien Bard
Keyword(s):  
Group A Streptococcus ◽  
Improve Patient Care ◽  
Routine Care ◽  
Streptococcal Pharyngitis ◽  
Molecular Testing ◽  
Culture Methods ◽  
Rapid Antigen Detection Test ◽  
Large Colony ◽  
Group A ◽  
Improve Patient

Abstract Background Group A Streptococcus (GAS) and large colony-forming group C (GCS) and G (GGS) β-hemolytic streptococci are important causes of acute pharyngitis in children and adults. Rapid and accurate diagnosis of streptococcal pharyngitis can improve patient care and potentially reduce transmission. In this study, we evaluated the performance of the Lyra Direct Strep (LDS) assay for detection of GAS and GCS/GGS compared with traditional culture methods. Methods Pharyngeal samples obtained from 278 children presenting to the emergency department with initial negative GAS rapid antigen detection test (RADT) were used. All samples were cultured as part of routine care and tested in batches using the LDS assay. Results Of 278 pharyngeal samples with negative GAS RADT, 37 (13.3%) and 63 (22.7%) patients were positive for GAS by culture and LDS assay, respectively. Four (1.4%) patients were positive for GCS or GGS by culture or LDS assay. The LDS assay demonstrated sensitivity and specificity of 97.6% and 89.0%, respectively, compared with culture as the gold standard. Repeat culture and an alternate PCR showed that 85.7% (24 of 28) of discrepant samples agreed with findings of the LDS assay. Since implementation, the LDS assay shows a positivity rate of 21.0% (281 of 1340) compared with 11.7% (246 of 2110) by culture in the previous year. Conclusions We successfully implemented the LDS assay at our institution and have observed a significant increase in the positivity rate of GAS compared with culture. The LDS assay alone allowed for the elimination of β-streptococci screening by culture at our institution.

scholarly journals 853. Epidemiology of Groups A, C, and G β-Hemolytic Streptococcal Pharyngitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S18-S19
Author(s):  
James Ray Mata Lim ◽  
Bobby L Boyanton ◽  
Julie George ◽  
Matthew Sims
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Group A Streptococcus ◽  
Retrospective Chart Review ◽  
Streptococcal Pharyngitis ◽  
Molecular Testing ◽  
Age Difference ◽  
Need For Treatment ◽  
Group A ◽  
Rheumatic Heart

Abstract Background Treatment of Group A Streptococcus (GAS) pharyngitis is imperative to mitigate sequelae such as rheumatic heart disease. The need for treatment of Group C Streptococcus (GCS) and Group G Streptococcus (GGS) pharyngitis is unclear, as rheumatogenic sequelae have not been well documented. Our institution switched from culture to molecular confirmation testing for a negative rapid streptococcal antigen detection test. Cultures reported GAS whereas molecular testing reported GAS, GCS, and GGS. We performed a retrospective chart review to examine the epidemiological differences of GAS, GCS, and GGS pharyngitis. Methods Records were obtained of pharyngeal samples from patients sent for testing at Beaumont Health Laboratory. In all, 92,369 records were analyzed. There were 47,106 records of cultures from May 2012 through December 2014 and 45,263 records of molecular testing from May 2015 to December 2017. Samples positive for either GCS or GGS were reported as positive for Group CG Streptococcus (GCGS). Epidemiological factors were evaluated. If available, electronic records from GCGS positive samples were evaluated for clinical features, antibiotics used, and sequelae or complications reported. Results Molecular testing showed GAS positivity of 9.3% (n = 4,189) and GCGS positivity of 1.5% (n = 687). GCGS pharyngitis was more likely during the summer months and in young adults 13 years and older than children under 13 years. GAS pharyngitis was more likely during spring months and in children aged 4–9 years. Mean age of GCGS pharyngitis was 13 vs. 8.6 years for GAS pharyngitis. Similar results were obtained for GAS between culture and molecular testing records. Amoxicillin was most often prescribed for treatment of GCGS. There were few instances of severe GCGS exudative or recurrent pharyngitis that required hospitalization or tonsillectomy. There were no cases of rheumatic fever or rheumatic heart disease associated with GCGS. Conclusion This is the largest study based on our literature review to evaluate the epidemiology of GAS, GCS, and GGS pharyngitis in children and adults. We found a seasonal and age difference between GAS and GCGS. Complications were rare, and no rheumatogenic sequelae were noted from GCGS infections. Disclosures All Authors: No reported Disclosures.

scholarly journals Evaluation of Rapid Antigen Detection Test for Group A Streptococci Pharyngitis among Children in an Out-Patient Clinic in Malaysia

2021 ◽  
Vol 50 (11) ◽  
pp. 3345-3354
Author(s):  
Zaili Zaki ◽  
Asrul Abdul Wahab ◽  
Ramliza Ramli ◽  
Afaaf Esa ◽  
Ezura Madiana Md. Monoto
Keyword(s):  
Sore Throat ◽  
Sensitivity And Specificity ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Antigen Detection ◽  
Preschool Age ◽  
Throat Culture ◽  
Care Clinic ◽  
Rapid Antigen Detection Test ◽  
Group A

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis.

scholarly journals Exhaustion of the immune system by Group A Streptococcus necrotizing fasciitis: the occurrence of late secondary infections in a retrospective study

2019 ◽  
Vol 4 (1) ◽  
pp. e000272 ◽  
Author(s):  
Femke Nawijn ◽  
Emma C E Wassenaar ◽  
Diederik P J Smeeing ◽  
Bart J M Vlaminckx ◽  
Jan Siert K Reinders ◽  
...  
Keyword(s):  
Immune System ◽  
Retrospective Study ◽  
Necrotizing Fasciitis ◽  
Group A Streptococcus ◽  
Frozen Section ◽  
Level Of Evidence ◽  
Adequate Treatment ◽  
Secondary Infections ◽  
Increased Risk ◽  
Group A

BackgroundNecrotizing fasciitis is a potentially lethal condition for which early and adequate treatment with surgical debridement and broad-spectrum intravenous antibiotics are essential for survival. It is hypothesized that Group A Streptococcus (GAS) necrotizing fasciitis causes exhaustion of the immune system, making these patients more susceptible for late secondary infections.MethodsA retrospective study was conducted of all patients with necrotizing fasciitis between 2002 and 2016. Patients with necrotizing fasciitis based on macroscopic findings, positive Gram staining, culture or fresh frozen section of fascia biopsies were included. Patients with necrotizing fasciitis were divided into two groups based on the presence of GAS. Of both groups, clinical course, outcome and occurrence of late secondary infections were analyzed. For the occurrence of secondary infections, pneumonia was chosen as reference for late secondary infections.ResultsEighty-one patients with necrotizing fasciitis were included of which 38 (47%) had GAS necrotizing fasciitis and 43 (53%) had non-GAS necrotizing fasciitis. Patients with GAS necrotizing fasciitis were younger (50 vs. 61 years, p=0.023) and more often classified as ASA I (45% vs. 14%, p=0.002) compared with patients with non-GAS necrotizing fasciitis. In-hospital mortality rate for necrotizing fasciitis was 32%. Patients with comorbidities were more likely to die of necrotizing fasciitis compared with patients without comorbidities (OR 7.41, 95% CI 1.58 to 34.63). Twelve patients (39%) with GAS necrotizing fasciitis developed pneumonia compared with four patients (13%) with non-GAS necrotizing fasciitis (p=0.017; OR 4.42, 95% CI 1.124 to 15.79). Median time from diagnosis to development of pneumonia in patients with GAS necrotizing fasciitis was 10 days (IQR 9).ConclusionPatients with GAS necrotizing fasciitis have an increased risk to develop late secondary infections during initial treatment for necrotizing fasciitis compared with patients with necrotizing fasciitis without involvement of GAS. This suggests exhaustion of the immune system after severe GAS infection.Level of evidenceIII

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