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Bakhit M, Gamage SK, Atkins T, Glasziou P, Hoffmann T, Jones M, Sanders S. Diagnostic performance of clinical prediction rules to detect group A beta-haemolytic streptococci in people with acute pharyngitis: a systematic review. Public Health 2024; 227:219-227. [PMID: 38241903 DOI: 10.1016/j.puhe.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To assess and compare the diagnostic performance of Clinical Prediction Rules (CPRs) developed to detect group A Beta-haemolytic streptococci in people with acute pharyngitis (or sore throat). STUDY DESIGN A systematic review. METHODS We searched PubMed, Embase and Web of Science (inception-September 2022) for studies deriving and/or validating CPRs comprised of ≥2 predictors from an individual's history or physical examination. Two authors independently screened articles, extracted data and assessed risk of bias in included studies. A meta-analysis was not possible due to heterogeneity. Instead we compared the performance of CPRs when they were validated in the same study population (head-to-head comparisons). We used a modified grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess certainty of the evidence. RESULTS We included 63 studies, all judged at high risk of bias. Of 24 derived CPRs, 7 were externally validated (in 46 external validations). Five validation studies provided data for head-to-head comparison of four pairs of CPRs. Very low certainty evidence favoured the Centor CPR over the McIsaac (2 studies) and FeverPain CPRs (1 study) and found the Centor CPR was equivalent to the Walsh CPR (1 study). The AbuReesh and Steinhoff 2005 CPRs had a similar poor discriminative ability (1 study). Within and between study comparisons suggested the performance of the Centor CPR may be better in adults (>18 years). CONCLUSION Very low certainty evidence suggests a better performance of the Centor CPR. When deciding about antibiotic prescribing for pharyngitis patients, involving patients in a shared decision making discussion about the likely benefits and harms, including antibiotic resistance, is recommended. Further research of higher rigour, which compares CPRs across multiple settings, is needed.
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Affiliation(s)
- Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | | | - Tiffany Atkins
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Sharon Sanders
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
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Alkhazi AA, Alessa KM, Almutairi AM, Almadi HA, Akkam A, Almutairi MK, Alhamad OA, Ghazal HS. Improving pediatric emergency department physicians' adherence to clinical practice guidelines on the diagnosis and management of group A beta-hemolytic streptococcal pharyngitis-a cross-sectional study. Int J Emerg Med 2019; 11:49. [PMID: 30768657 PMCID: PMC6326116 DOI: 10.1186/s12245-018-0209-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Pharyngitis is one of the major and commonly seen presentations in pediatric emergency departments. While it could be caused by both bacterial and viral pathogens, antibiotics are improperly prescribed regardless of the pathogen. Inappropriate usage of antibiotics has risen the concern of microbial resistance and the need for stricter guidelines. Many guidelines have been validated for this reason, and the Centor score (Modified/McIsaac) is most commonly implemented. This study aims to assess the adherence and enumerate the reasons behind the suboptimal adherence to guidelines (Centor/McIsaac score) of pediatric emergency department physicians in the diagnosis and management of GABHS pharyngitis to lay the groundwork for future actions and to employ educational programs and implement local guidelines for the prevention of the development of multi-drug resistant microorganisms. Methodology We surveyed pediatric emergency department physicians of ten teaching hospitals of Riyadh, Saudi Arabia. We used convenient sampling and estimated a sample size of 170 physicians, and interns and medical centers without pediatric emergency department were excluded from the study. Elements of the Centor score (Modified/McIsaac) were used as a part of the assessment of physicians’ knowledge of the guidelines. Adherence was assessed by requiring the participants to answer questions regarding their usage of diagnostic means when they suspect a bacterial cause of pharyngitis, as recommended by the guidelines. Results A total of 243 physicians answered the questionnaire, 43 consultants (17.6%) and 200 non-consultants (82.4%). On the knowledge score, 9.1% scored 0, and the majority of both groups, 46.5%, earned a score of 1. The remainder 44.4%, earned a score of 2. Adherence to guidelines was defined as when diagnostic tests (throat culture or rapid antigen detection test) were always requested prior to prescribing antibiotics when acute bacterial pharyngitis was suspected. Only 27.3% (n = 67) of our sample are adherent to guidelines, whereas the majority, 72.7% (n = 175), are non-adherent. Several factors were assessed as reasons for lack of adherence. Conclusion Lack of knowledge and adherence to guidelines is prevalent in our setting, with awareness, knowledge, and behavior of physicians playing as major factors behind this low adherence. Studies should aim towards the assessment of adherence towards locally developed guidelines.
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Affiliation(s)
- Ahmed A Alkhazi
- Department of Pediatric, College of Medicine, Al Imam Mohammad ibn Saud Islamic University (IMSIU), Othman ibn Affan Road, Exit 5, P.O. Box: 7544, Riyadh, Saudi Arabia
| | - Khalid M Alessa
- Department of Pediatric, College of Medicine, Al Imam Mohammad ibn Saud Islamic University (IMSIU), Othman ibn Affan Road, Exit 5, P.O. Box: 7544, Riyadh, Saudi Arabia
| | - Ahmed M Almutairi
- Department of Pediatric, College of Medicine, Al Imam Mohammad ibn Saud Islamic University (IMSIU), Othman ibn Affan Road, Exit 5, P.O. Box: 7544, Riyadh, Saudi Arabia
| | - Hamad A Almadi
- 2Pediatric Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdullah Akkam
- 2Pediatric Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed K Almutairi
- Pediatric Emergency Department, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
| | - Omar A Alhamad
- Department of Pediatric, College of Medicine, Al Imam Mohammad ibn Saud Islamic University (IMSIU), Othman ibn Affan Road, Exit 5, P.O. Box: 7544, Riyadh, Saudi Arabia
| | - Hadeel S Ghazal
- 4Department of Pediatric Emergency, College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAUHS), Riyadh, Saudi Arabia
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Nascimento BR, Sable C, Nunes MCP, Diamantino AC, Oliveira KKB, Oliveira CM, Meira ZMA, Castilho SRT, Santos JPA, Rabelo LMM, Lauriano KCA, Carmo GAL, Tompsett A, Ribeiro ALP, Beaton AZ. Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study. J Am Heart Assoc 2018; 7:JAHA.117.008039. [PMID: 29444774 PMCID: PMC5850205 DOI: 10.1161/jaha.117.008039] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Considering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (RHD), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil. Methods and Results The PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart Federation criteria. Compliance with study consent and prevalence were compared between different screening settings, and variables associated with RHD were analyzed. In 26 months, 12 048 students were screened in 52 public schools (n=10 901), 2 private schools (n=589), and 3 primary care centers (n=558). Median age was 12.9 years, and 55.4% were girls. Overall RHD prevalence was 4.0% borderline (n=486) and 0.5% definite (n=63), with statistically similar rates between public schools (4.6%), private schools (3.5%), and primary care centers (4.8%) (P=0.24). The percentage of informed consents signed was higher in primary care centers (84.4%) and private schools (66.9%) compared with public schools (38.7%) (P<0.001). Prevalence was higher in children ≥12 years (5.3% versus 3.1%; P<0.001) and girls (4.9% versus 4.0%; P=0.02). Only age (odds ratio, 1.12; 95% confidence interval, 1.09–1.17; P<0.001) was independently associated with RHD. Conclusions RHD screening in primary care centers seems to achieve higher coverage rates. Prevalence among schoolchildren is significantly high, with rates higher than expected in private schools of high‐income areas. These data are important for the formulation of public policies to confront RHD.
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Affiliation(s)
- Bruno R Nascimento
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil .,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Craig Sable
- Children's National Health System, Washington, DC
| | - Maria Carmo P Nunes
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriana C Diamantino
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kaciane K B Oliveira
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cassio M Oliveira
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Zilda Maria A Meira
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra Regina T Castilho
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Júlia P A Santos
- School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Letícia Maria M Rabelo
- School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Karlla C A Lauriano
- School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gabriel A L Carmo
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Antonio Luiz P Ribeiro
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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