The role of point of care testing for patients with acute pharyngitis

BACKGROUND: There is no consensus favoring a particular strategy for evaluating patients with pharyngitis. OBJECTIVE: To compare a clinical decision aid and a rapid office-based point of care (POC) test with routine culture for group A beta-hemolytic streptococcus (GAS). DESIGN: Prospective observational study. PARTICIPANTS: Among 179 patients enrolled, 150 were eligible and 148 had POC testing and cultures initially performed. MEASUREMENTS: An encounter form included eligibility criteria, clinical information based upon the Centor rule, and treatment provided. Sensitivity and specificity of POC test compared to routine culture for GAS. RESULTS: Thirty-eight patients (25.7%) had a positive GAS culture. The POC test was 92.1% sensitive (95% confidence interval [CI] 80% to 98%) and 100% specific (95% CI 97% to 100%). Although the Centor rule did not adequately discriminate among symptomatic patients with or without GAS (receiver operating curve area 0.63), the 3 patients with a false-negative POC test had a Centor score of less than 2. Among patients with a negative POC test, 26% initially received antibiotics. CONCLUSION: For patients with a Centor score of >= 2, a POC test was highly sensitive for GAS. Future studies should confirm these results and assess whether implementation of POC testing as part of a local practice guideline can decrease variability in testing and treatment.