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Rankin DA, Peetluk LS, Deppen S, Slaughter JC, Katz S, Halasa NB, Khankari NK. Diagnostic models predicting paediatric viral acute respiratory infections: a systematic review. BMJ Open 2023; 13:e067878. [PMID: 37085296 PMCID: PMC10124282 DOI: 10.1136/bmjopen-2022-067878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/03/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To systematically review and evaluate diagnostic models used to predict viral acute respiratory infections (ARIs) in children. DESIGN Systematic review. DATA SOURCES PubMed and Embase were searched from 1 January 1975 to 3 February 2022. ELIGIBILITY CRITERIA We included diagnostic models predicting viral ARIs in children (<18 years) who sought medical attention from a healthcare setting and were written in English. Prediction model studies specific to SARS-CoV-2, COVID-19 or multisystem inflammatory syndrome in children were excluded. DATA EXTRACTION AND SYNTHESIS Study screening, data extraction and quality assessment were performed by two independent reviewers. Study characteristics, including population, methods and results, were extracted and evaluated for bias and applicability using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and PROBAST (Prediction model Risk Of Bias Assessment Tool). RESULTS Of 7049 unique studies screened, 196 underwent full text review and 18 were included. The most common outcome was viral-specific influenza (n=7; 58%). Internal validation was performed in 8 studies (44%), 10 studies (56%) reported discrimination measures, 4 studies (22%) reported calibration measures and none performed external validation. According to PROBAST, a high risk of bias was identified in the analytic aspects in all studies. However, the existing studies had minimal bias concerns related to the study populations, inclusion and modelling of predictors, and outcome ascertainment. CONCLUSIONS Diagnostic prediction can aid clinicians in aetiological diagnoses of viral ARIs. External validation should be performed on rigorously internally validated models with populations intended for model application. PROSPERO REGISTRATION NUMBER CRD42022308917.
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Affiliation(s)
- Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lauren S Peetluk
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Deppen
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Sophie Katz
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nikhil K Khankari
- Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Passali D, Barat V, Cadevall O, Freire HM, Grattagliano I, Gutu I, Mösges R, Pavlysh A. International Delphi-based consensus on the appropriate use and effect of Benzydamine hydrochloride in the treatment of sore throat. BMC PRIMARY CARE 2022; 23:296. [PMID: 36419002 PMCID: PMC9685970 DOI: 10.1186/s12875-022-01901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Benzydamine hydrochloride is a locally-acting Non-Steroidal Anti-Inflammatory Drug (NSAID) with combined local anesthetic and analgesic properties, indicated for the symptomatic relief of pain in acute sore throat. The aim of this study was to obtain an European Consensus among pharmacists, general practitioners and pediatricians on the appropriate use of benzydamine hydrochloride in the treatment of sore throat. METHODS The authors developed a Delphi questionnaire organized into 15 statements focused on 4 topics: the mechanism of action of benzydamine, the benzydamine treatment in an adult patient and in a pediatric patient, and the advantages of benzydamine over other topical treatments. The survey was administered to a panel of to 320 participants including general practitioners, pediatricians, and pharmacists from 6 European countries (Italy, Germany, Portugal, Romania, Russia, and Spain), who rated their level of agreement or disagreement with each statement on a 6-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with each statement. RESULTS Panelists' agreement on statements was very high. Consensus was reached for all 15 statements in the Delphi survey, with more than 98% positive agreement on topic 4, suggesting a shared view among European healthcare professionals (HCPs) about the advantages of benzydamine over other topical treatments. A strong consensus (> 99%) was reached for all the statements of topic 1 regarding the mechanism of action of benzydamine, except for its anesthetic properties (79%). Strong agreement was reached for all statements in topics 2 and 3 regarding the treatment of acute sore throat symptoms in the adult and pediatric patient, except for one on the efficacy of benzydamine in preventing post-operative sore throat, for which it was 67%. CONCLUSION Because all relevant publications on benzydamine are dated and there are no recommendations on its use for the symptomatic treatment of sore throat in European guidelines, this Delphi-based international consensus may be important in reinforcing the appropriate use and effect of benzydamine in the treatment of sore throat among health care professionals.
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Affiliation(s)
- Desiderio Passali
- International Federation ORL Societies (IFOS) Executive Board members, Rome, Italy
| | - Veronica Barat
- grid.415778.80000 0004 5960 9283AOU Città della Salute e della Scienza di Torino, Regina Margherita Children’s Hospital, Turin, Italy
| | - Olga Cadevall
- grid.497607.b0000 0004 1808 0870Clínica Rotger, Quirónsalud, Palma de Mallorca, Spain
| | - Hugo Miguel Freire
- Sociedade Portuguesa de Farmacêuticos dos Cuidados de Saúde, Coimbra, Portugal
| | | | - Ioan Gutu
- General Practitioner, Vaslui, Romania
| | - Ralph Mösges
- grid.6190.e0000 0000 8580 3777Institute of Medical Statistics, and Computational Biology (IMSB), Medical Faculty, University at Cologne, Cologne, Germany
| | - Andrey Pavlysh
- grid.445925.b0000 0004 0386 244XNorth-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
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Ivaska L, Niemelä J, Gröndahl-Yli-Hannuksela K, Putkuri N, Vuopio J, Vuorinen T, Waris M, Rantakokko-Jalava K, Peltola V. Detection of group A streptococcus in children with confirmed viral pharyngitis and antiviral host response. Eur J Pediatr 2022; 181:4059-4065. [PMID: 36163516 PMCID: PMC9512968 DOI: 10.1007/s00431-022-04633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 08/05/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Our aim was to study the detection of group A streptococcus (GAS) with different diagnostic methods in paediatric pharyngitis patients with and without a confirmed viral infection. In this prospective observational study, throat swabs and blood samples were collected from children (age 1-16 years) presenting to the emergency department with febrile pharyngitis. A confirmed viral infection was defined as a positive virus diagnostic test (nucleic acid amplification test [NAAT] and/or serology) together with an antiviral immune response of the host demonstrated by elevated (≥ 175 µg/L) myxovirus resistance protein A (MxA) blood concentration. Testing for GAS was performed by a throat culture, by 2 rapid antigen detection tests (StrepTop and mariPOC) and by 2 NAATs (Simplexa and Illumigene). Altogether, 83 children were recruited of whom 48 had samples available for GAS testing. Confirmed viral infection was diagnosed in 30/48 (63%) children with febrile pharyngitis. Enteroviruses 11/30 (37%), adenoviruses 9/30 (30%) and rhinoviruses 9/30 (30%) were the most common viruses detected. GAS was detected by throat culture in 5/30 (17%) with and in 6/18 (33%) patients without a confirmed viral infection. Respectively, GAS was detected in 4/30 (13%) and 6/18 (33%) by StrepTop, 13/30 (43%) and 10/18 (56%) by mariPOC, 6/30 (20%) and 9/18 (50%) by Simplexa, and 5/30 (17%) and 6/18 (30%) patients by Illumigene. CONCLUSION GAS was frequently detected also in paediatric pharyngitis patients with a confirmed viral infection. The presence of antiviral host response and increased GAS detection by sensitive methods suggest incidental throat carriage of GAS in viral pharyngitis. WHAT IS KNOWN •The frequency and significance of GAS-virus co-detection are poorly characterised in children with pharyngitis. •Detection of a virus and the antiviral host response likely indicates symptomatic infection. WHAT IS NEW •Group A streptococcus (GAS) was detected in 17-43% of the children with confirmed viral pharyngitis depending on the GAS diagnostic method. •Our results emphasize the risk of detecting and treating incidental pharyngeal carriage of GAS in children with viral pharyngitis.
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Affiliation(s)
- Lauri Ivaska
- Departments of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland. .,Emergency Services, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jussi Niemelä
- grid.410552.70000 0004 0628 215XDepartments of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XEmergency Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Kirsi Gröndahl-Yli-Hannuksela
- grid.1374.10000 0001 2097 1371Medical Microbiology and Immunology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Niina Putkuri
- grid.410552.70000 0004 0628 215XDivision of Clinical Microbiology, Turku University Hospital, Turku, Finland ,grid.452433.70000 0000 9387 9501Finnish Red Cross, Blood Service, Helsinki, Finland
| | - Jaana Vuopio
- grid.1374.10000 0001 2097 1371Medical Microbiology and Immunology, Institute of Biomedicine, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDivision of Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Tytti Vuorinen
- grid.1374.10000 0001 2097 1371Medical Microbiology and Immunology, Institute of Biomedicine, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDivision of Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Matti Waris
- grid.1374.10000 0001 2097 1371Medical Microbiology and Immunology, Institute of Biomedicine, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDivision of Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Kaisu Rantakokko-Jalava
- grid.410552.70000 0004 0628 215XDivision of Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Ville Peltola
- grid.410552.70000 0004 0628 215XDepartments of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
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Oliver J, Upton A, Jack SJ, Pierse N, Williamson DA, Baker MG. Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010-2016. Emerg Infect Dis 2021; 26:1113-1121. [PMID: 32441618 PMCID: PMC7258449 DOI: 10.3201/eid2606.181462] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Group A Streptococcus (GAS) pharyngitis is a key initiator of acute rheumatic fever (ARF). In New Zealand, ARF cases occur more frequently among persons of certain ethnic and socioeconomic groups. We compared GAS pharyngitis estimates (1,257,058 throat swab samples) with ARF incidence (792 hospitalizations) in Auckland during 2010–2016. Among children 5–14 years of age in primary healthcare clinics, GAS pharyngitis was detected in similar proportions across ethnic groups (≈19%). Relative risk for GAS pharyngitis was moderately elevated among children of Pacific Islander and Māori ethnicities compared with those of European/other ethnicities, but risk for ARF was highly elevated for children of Pacific Islander and Māori ethnicity compared with those of European/other ethnicity. That ethnic disparities are much higher among children with ARF than among those with GAS pharyngitis implies that ARF is driven by factors other than rate of GAS pharyngitis alone.
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ASLANER H, MISTIK S, ERTÜRK ZARARSIZ G, KILIÇ H, ÇETİN BENLİ N. Evaluation of the Use of the Mistik Score and Modified Centor Score in Sore Throat. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.839462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Meskina ER, Stashko TV. [How to reduce the antibacterial load in the treatment of acute tonsillitis and pharyngitis? Possible tactics and practical approaches]. Vestn Otorinolaringol 2021; 85:90-99. [PMID: 33474925 DOI: 10.17116/otorino20208506190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute tonsillopharyngitis is one of the most frequent reasons for visiting a doctor and prescribing inappropriate antibiotic therapy (ABT). There are several reasons for this - from the difficulties of etiological diagnosis and the development of relapses and possible severe complications to the personal attitude of doctors and patients to the choice of treatment. At the same time, the issue of antibiotic resistance and other aspects associated with the prescription of ABT is one of the most important problems of modern healthcare worldwide. The purpose of this review is to demonstrate the best practical approaches to the choice of treatment tactics for acute tonsillitis (AT) in the treatment of children and adults, with an emphasis on reducing the load of ABT. The review examines the indications and disadvantages of clinical and laboratory diagnosis of AT. There are no highly sensitive clinical and laboratory instruments that differentiate viral and bacterial AT. Exudativeis AT in children is not an underlying symptom of streptococcal etiology. Despite the limitations, the modified Centor/McIsaac score ≥3 (taking into account age and the presence of respiratory symptoms) should be used as an indication for ABT in conjunction with a rapid streptotest and subsequent bacteriological culture for S. pyogenes if the screening test is negative. Additional examinations (determination of leukocytosis, CRP and procalcitonin test) are not required for most patients. ABT should not be given to low-risk patients for the treatment and prevention of rheumatic fever and acute glomerulonephritis. Prevention of purulent complications (paratonsillitis and retropharyngeal abscess, acute otitis media, cervical lymphadenitis, mastoiditis, or acute sinusitis) is not a specific indication for ABT in AT and is not required in most patients. The strategy of «delayed antibiotic prescriptions» with monitoring the patient's condition for 2-3 days is appropriate and highly effective in doubtful cases. The drugs of choice for treatment of AT are amoxicillin and oral forms of I and II generation cephalosporins. Macrolides are not indicated as first-line treatment for AT. The course of ABT for streptococcal AT is 10 days, which reduces the risk of recurrent episode. Topical drugs can be the only means of etiopathogenetic treatment with viral AT, or additional for bacterial AT. Their use not only relieves sore throat, but also shortens the duration of the disease, and also improves the patients prognosis. Benzalkonium chloride + tyrothricin + benzocaine (Dorithyrcin) may be a rational drug of choice for topical therapy due to the available clinical evidence. There is a significant reserve for reducing the load of ABT during AT. Further clinical trials are needed to assess the efficacy of short courses of ABT in the treatment of AT in high-income countries and provide a basis for strong recommendations for topical drug use. This can reduce the frequency of ABT prescribing and increase the level of interaction between specialists and patients.
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Affiliation(s)
- E R Meskina
- Moscow Regional Research and Clinical Institute (MONIKI), Moskow, Russia
| | - T V Stashko
- Moscow Regional Research and Clinical Institute (MONIKI), Moskow, Russia
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Aslaner H, Aslaner HA, Ertürk Arik B, Onuk FA, Benli AR, Mistik S. Rapid Antigen Detection Test Using Rates of Family Physicians, Test Results and Its Impact on Their Prescription Behaviours. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of this study is to determine the rates of rapid antigen detection test use, test results and its relationship with Modified Centor Score and investigate the effect of rapid antigen detection test use on prescribing behaviour.
Methods: This research was conducted by scanning the family physicians’ information system retrospectively. From the Family Medicine Information System, where polyclinics and prescription records of the family health centers where 12 family physicians work in Kayseri are located, the number and results of rapid antigen detection tests performed between February 2017 and April 2019, the Modified Centor Score automatically calculated by the system, the number of prescribed antibiotics and symptomatic treatment information was recorded.
Results: The positivity of rapid antigen detection test was considered, cut-off value of Modified Centor Score was >2 (ROC EAA:63.9, Cl:0.95,0.61-0.66). Sensitivity rate of the test for diagnostic score was 86% and selectivity rate was 48.8%.
Conclusion: Family physicians should be encouraged to use rapid antigen detection test. The fact that antibiotics are prescribed in rapid antigen detection testnegative patients may indicate that confidence level of the test is less than physical examination and clinical findings.
Keywords: sore throat, primary care, score
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Affiliation(s)
| | | | | | | | | | - Selcuk Mistik
- Department of Family Practice, Faculty of Medicine, Erciyes University
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Parthasarathy R, Kumar R, Gopal G, Amarchand R, Broor S, Choudekar A, Purakayastha DR, Wahi A, Narayan VV, Krishnan A. Incidence and clinical features of viral sore throat among children in rural Haryana, India. J Family Med Prim Care 2020; 9:5136-5141. [PMID: 33409177 PMCID: PMC7773104 DOI: 10.4103/jfmpc.jfmpc_759_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/11/2020] [Accepted: 07/11/2020] [Indexed: 11/04/2022] Open
Abstract
Background Sore throat is one of the commonest symptoms that patients present to a primary care physician. We describe the epidemiology of sore throat and performance of an algorithm to predict viral sore throat in a part of India. Methods Children below 10 years of age were followed in 4 villages of Haryana, India from Aug 2012 to Aug 2014 through weekly domiciliary visits by trained field workers who screened for symptoms of acute respiratory infection (ARI) including sore throat. Nasal and throat swabs were obtained from a random sample of sore throat cases by nurses and sent in appropriate transport media for real-time polymerase chain reaction for detection of viral nucleic acid. Incidence of sore throat and viral sore throat are reported as number of sore throat episodes per 1000 child-years (EPTCY) with 95% confidence-interval (CI). Symptoms, associated with viral sore throat were identified by logistic regression, combined into a clinical score and Receiver Operating Characteristic curve was plotted. Results Over a two-year period, 3765 children were followed up for 5578 child years. 1069 episodes of sore throat were reported, and swabs were collected from 8% of the cases randomly. The incidence of sore throat and viral sore throat was 191.7 (95%CI: 180.5-203.6) and 60.1 (95%CI: 55.1-68.2) EPTCY, respectively. Fever (aOR 5.40,95%CI: 1.16-25.18) and running nose (aOR 10.16,95%CI: 1.01-102.42) was significantly associated with viral sore throat. The clinical score (fever, running nose, and headache) had an overall sensitivity of 86.2% (68.3-96.1%), specificity of 62% (47.2-75.3%) and AUC of 0.78 (0.67-0.87) in predicting viral sore throat. Conclusion Viruses contributed to one-third of burden of sore throat and clinical score can be used in primary care settings to aid antibiotic prescription by physicians.
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Affiliation(s)
- Raghavan Parthasarathy
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Giridara Gopal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Broor
- Centre for Chronic Diseases Control, Gurugram, Haryana, India
| | - Avinash Choudekar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Abhishek Wahi
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds. Br J Gen Pract 2020; 70:e245-e254. [PMID: 32152041 PMCID: PMC7065683 DOI: 10.3399/bjgp20x708833] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/15/2019] [Indexed: 01/14/2023] Open
Abstract
Background Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis. Aim To compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with pharyngitis. Design and setting A meta-analysis of diagnostic test accuracy studies conducted in primary care was performed using a novel model that incorporates data at multiple thresholds. Method MEDLINE, EMBASE, and PsycINFO were searched for studies published between January 1980 and February 2019. Included studies were: cross-sectional; recruited patients with sore throats from primary care; used the Centor or McIsaac score; had GABHS infection as the target diagnosis; used throat swab culture as the reference standard; and reported 2 × 2 tables across multiple thresholds. Selection and data extraction were conducted by two independent reviewers. QUADAS-2 was used to assess study quality. Summary receiver operating characteristic (SROC) curves were synthesised. Calibration curves were used to assess the transferability of results into practice. Results Ten studies using the Centor score and eight using the McIsaac score were included. The prevalence of GABHS ranged between 4% and 44%. The areas under the SROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The P-value for the difference (0.0164) was 0.419, suggesting the SROC curves for the tests are equivalent. Both scores demonstrated poor calibration. Conclusion Both Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection.
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Hızlı Ş, ALTAY FM. Evaluation of Symptoms and Findings in Children with Tonsillopharyngitis Reflecting The Presence of Beta Hemolytic Streptococcal Infection. ANKARA MEDICAL JOURNAL 2019. [DOI: 10.17098/amj.575478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Takahashi K, Fujimoto T, Hanaoka N, Tamura M, Suzuki Y, Sugihara S. Useful manifestations to detect adenovirus in children with upper respiratory infections: A retrospective study. J Med Virol 2019; 94:582-586. [PMID: 31021428 DOI: 10.1002/jmv.25492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/27/2019] [Accepted: 04/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Approximately 1 million adenovirus immunochromatography (IC) kits are annually used in Japan. However, no practical strategies have been developed regarding their use for detecting adenovirus. The present study aims to verify the usefulness of clinical manifestations in making decisions regarding the use of adenovirus IC kits for children with upper respiratory infections (URI). METHODS The medical records of 825 pediatric cases tested by IC kits for adenovirus were extracted from clinical laboratory department database over a 3-year period at our hospital. Among them, 585 patients were suspected adenovirus URI, and their clinical manifestations were reviewed. After data cleaning, 10 types of clinical manifestations were statistically analyzed between adenovirus IC kit-positive and -negative groups. Multivariate analysis was performed to select significant clinical manifestations using adenovirus IC kit positivity as the objective variable. RESULTS Among 585 pediatric patients, the cases of 420 patients, with suitable data for whom no other pathogen was detected, were reviewed. Adenovirus was detected in 86 cases. Multivariate analysis identified a significant difference for three clinical manifestations: (1) fever ≥ 39.0°C, (2) rhinorrhea, and (3) tonsillar exudate. The negativity rate for the IC kit was 90% when none of the three manifestations was observed. CONCLUSIONS The results suggested that IC kits for adenovirus tend to give negative results in cases that lack all the three above mentioned clinical manifestations.
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Affiliation(s)
- Kenichiro Takahashi
- Department of Pediatrics, Shin Matsudo Central General Hospital, Chiba, Japan.,Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.,Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Nozomu Hanaoka
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mariko Tamura
- Department of Pediatrics, Shin Matsudo Central General Hospital, Chiba, Japan
| | - Yoko Suzuki
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Shigetaka Sugihara
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Stuhr JK, Lykkegaard J, Kristensen JK, Kornum JB, Hansen MP. Danish GPs' and practice nurses' management of acute sore throat and adherence to guidelines. Fam Pract 2019; 36:192-198. [PMID: 29924311 DOI: 10.1093/fampra/cmy059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sore throat is a frequent presentation of acute respiratory tract infections in general practice. Though these infections are often harmless and self-limiting, antibiotics are frequently prescribed. In Denmark, practice nurses manage an increasing part of patients with acute minor illnesses. OBJECTIVES We aimed (i) to investigate Danish practice nurses' and GPs' management of patients presenting with a sore throat and (ii) to explore to what extent management is according to current Danish guidelines. METHODS A cross-sectional study was conducted during winter 2017, involving GPs and practice nurses in Danish general practices. Patients with a sore throat were registered according to the Audit Project Odense method. RESULTS A total of 44 practices participated with the registration of 1503 patients presenting with a sore throat. Most patients had a strep A test performed, especially when managed by a practice nurse (84.6% versus 61.8%, χ2 = 90.1, P < 0.05). In total, 40.6% of performed strep A tests were not according to guideline recommendations. Antibiotics were prescribed for about one-third of patients, regardless whether managed by a practice nurse or a GP (χ2 = 0.33, P = 0.57). However, 32.4% of these prescriptions were not in line with Danish guidelines. CONCLUSION Patients with acute sore throat were managed similarly by GPs and practice nurses, apart from a higher use of strep A tests in patients seen by practice nurses. Importantly, this study demonstrated that there is still room for improvement of the management of these patients in Danish general practice.
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Affiliation(s)
- Janni Katharina Stuhr
- Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Lykkegaard
- Audit Project Odense, Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jette Kolding Kristensen
- Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Malene Plejdrup Hansen
- Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Thai TN, Dale AP, Ebell MH. Signs and symptoms of Group A versus Non-Group A strep throat: A meta-analysis. Fam Pract 2018; 35:231-238. [PMID: 29045629 DOI: 10.1093/fampra/cmx072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Both non-Group A streptococcal (non-GAS) pharyngitis and Group A streptococcal (GAS) pharyngitis are commonly found in patients with sore throat. It is not known whether or not they present with similar signs and symptoms compared to patients with non-streptococcal pharyngitis. METHODS MEDLINE was searched for prospective studies that reported throat culture for both GAS and non-GAS as a reference standard, and reported at least one sign, symptom, or the Centor score. Summary estimates of sensitivity, specificity, likelihood ratios (LR+ and LR-), and diagnostic odds ratios (DOR) were calculated using a bivariate random effects model. Summary receiver operating characteristic (ROC) curves were created for key signs and symptoms. RESULTS Eight studies met our inclusion criteria. Tonsillar exudate had the highest LR+ for both GAS and non-GAS pharyngitis (1.53 versus 1.71). The confidence intervals of sensitivity, LR+, LR-, and DOR for all signs, symptoms, and the Centor score between two groups overlapped, with the relative difference between sensitivities within 15% for arthralgia or myalgia, fever, injected throat, tonsillar enlargement, and tonsillar exudate. Larger differences in sensitivities were observed for sore throat, cervical adenopathy, and lack of a cough, although the difference for lack of a cough largely due to a single outlier. DISCUSSION Signs and symptoms of patients with GAS and non-GAS pharyngitis are generally similar. No signs or symptoms clearly distinguish GAS from non-GAS infection. Further work is needed to determine whether Group C streptococcus is a pathogen that should be treated.
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Affiliation(s)
- Thuy N Thai
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, USA
| | - Ariella P Dale
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, USA
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, USA
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14
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Nishiyama M, Morioka I, Taniguchi-Ikeda M, Mori T, Tomioka K, Nakanishi K, Fujimura J, Nishimura N, Nozu K, Nagase H, Ishibashi K, Ishida A, Iijima K. Clinical features predicting group A streptococcal pharyngitis in a Japanese paediatric primary emergency medical centre. J Int Med Res 2018. [PMID: 29517940 PMCID: PMC5991234 DOI: 10.1177/0300060517752954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To identify clinical features that predict Group A streptococcal (GAS) pharyngitis in a Japanese paediatric primary emergency medical centre. Methods The prevalence of GAS pharyngitis according to age and body temperature (BT) was calculated among 3098 paediatric patients with pharyngitis. The numbers of GAS-positive and -negative patients for each clinical parameter, and each point increase in the McIsaac score were compared and likelihood ratios (LRs) were calculated. Results The prevalence of GAS pharyngitis was extremely low in patients aged < 1 (1.2%) and 1 year (3.9%). The GAS-positive rate was significantly higher in patients with a BT < 38.0°C compared with ≥ 38.0°C (30.0% vs. 19.8%). A BT ≥ 38.0°C was not a predictive finding for GAS pharyngitis (positive LR: 0.82). Rash was the most useful individual predictor, and a McIsaac score of 4 or 5 increased the probability; however, the positive LRs were 1.74 and 1.30, respectively. Conclusions The prevalence of GAS pharyngitis is extremely low in patients aged < 1 and 1 year, and a BT ≥ 38.0°C is not a predictive symptom. Although a rash and McIsaac score of 4 or 5 are associated with an increased probability, they cannot be used to confirm GAS infection.
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Affiliation(s)
- Masahiro Nishiyama
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Ichiro Morioka
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Mariko Taniguchi-Ikeda
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Takeshi Mori
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Kazumi Tomioka
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Keita Nakanishi
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Junya Fujimura
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Noriyuki Nishimura
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Kandai Nozu
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | - Hiroaki Nagase
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
| | | | - Akihito Ishida
- 2 Kobe Children's Primary Emergency Medical Center, Kobe, Japan
| | - Kazumoto Iijima
- 1 Department of Paediatrics, 236610 Kobe University Graduate School of Medicine , Kobe, Japan
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15
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Furuncuoğlu Y, Sağlam F, Kutluhan A. Acute exudative tonsillitis in adults: the use of the Centor scoreand some laboratory tests. Turk J Med Sci 2016; 46:1755-1759. [PMID: 28081323 DOI: 10.3906/sag-1510-93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/16/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of our study was to determine the usefulness of the Centor score and some basic laboratory tests (complete blood count and C-reactive protein) for the differential diagnosis of exudative tonsillitis due to Group A β-hemolytic streptococcus (GABHS) or due to non-GABHS agents. MATERIALS AND METHODS The data of clinical and laboratory characteristics of the patients diagnosed with exudative tonsillitis were collected and statistically compared between those having positive GABHS throat culture result and those who were negative for any bacterial agent. RESULTS Totally 899 adult patients were included in our study; 56 (6.2%) of them were positive for GABHS, while 34 (3.8%) of the cases had a bacterial cause other than GABHS. The remaining 809 (90%) were accepted as non-GABHS cases. The percentages of patients having Centor score of 3 or greater, neutrophilia, lymphocytopenia, and CRP values of greater than 5-fold normal upper reference range were significantly higher in GABHS patients. CONCLUSION Centor score of 3 or more together with high CRP, neutrophilia, and lymphocytopenia is predictive for GABHS tonsillopharyngitis.
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Affiliation(s)
- Yavuz Furuncuoğlu
- Department of Internal Medicine, Faculty of Medicine, Bahçeşehir University, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Filiz Sağlam
- Department of Medical Microbiology, Faculty of Medicine, Bahçeşehir University, İstanbul, Turkey
| | - Ahmet Kutluhan
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Norman WV. Our struggle to implement best practices: the example of antibiotic prescription for respiratory tract infection. Fam Pract 2015; 32:365-6. [PMID: 26163508 DOI: 10.1093/fampra/cmv055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
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