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Emergency department testing for Streptococcus in children with sore throats
  1. K Enright,
  2. S Taheri,
  3. T Beattie
  1. Royal Hospital for Sick Children, Edinburgh, UK
  1. Dr K Enright, Emergency Department, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK; kevin.enright{at}

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Fever is a common presentation among children attending emergency departments. Diagnosis of the source remains a clinical challenge. Pharyngitis will often be considered, especially in the older child complaining of sore throat. Throat swabbing has traditionally been part of the investigation. This is primarily to test for group A β-haemolytic streptococcus (GABHS) and to guide antibiotic therapy. A near-patient test such as rapid streptococcal tests (RSTs) for GABHS would appear to offer a convenient solution in the acute setting.

RSTs have been available for some time for bedside diagnosis. The American Academy of Pediatrics advises that local validation of these test kits be performed prior to their introduction in a clinical setting.1 This is all the more pertinent in the context of a busy children’s emergency department where the volume or complexity of patients, time pressures and targets, and the large numbers of staff involved in testing might make quality control especially challenging. This has been found to be the case in previous studies.2

We recently performed RST for GABHS on over 200 children ranging in age from 6 months to 13 years with a presentation consistent with symptomatic pharyngitis. We hoped to improve upon the results from previous work.3

Our audit demonstrated high specificity (98.6%) but poor sensitivity (71%) when comparison was made with standard swab microscopy, culture and sensitivity. The assay we used had been validated in other contexts previously, demonstrating 99% specificity and 92% sensitivity (product manufacturer’s information).

We contend that the limited reliability demonstrated in our audit relates to the context in which the test was performed and not to any failure of the assay. We suggest that use of RSTs requires online support from either the product manufacturer or in-house laboratory staff, or from dedicated emergency department staff members responsible for the swabbing and testing process.




  • Competing interests: None.