Aims and Objectives The UK in the winter of 2022/23 experienced high rates of Group A Streptococcal disease (GAS) and viral co-circulation in the community with an increase in GAS-associated mortality. This resulted in high numbers of attendances to Emergency Departments (EDs) from concerned families putting further strain on already bursting EDs. The approval of a national interim guideline was announced to support clinical diagnosis & appropriate use of antimicrobials.

We describe the implementation of a rapid molecular test (ID NOWTM Strep A 2, Abbott) in a busy Paediatric ED.

Method and Design In patients <= 16years old presenting with symptoms/signs of possible GAS during Feb - April 2023, rapid molecular GAS testing was obtained alongside a throat culture, this was using FeverPAIN score as per NICE guideline NG 84. Patients >3yrs in whom there was diagnostic uncertainty ie FeverPAIN 2/3 had a GAS POC and throat swab, those with FeverPAIN 4/5 were treated empirically and had a throat culture sent.

Results and Conclusion During the study period we obtained 405 rapid molecular GAS tests in 400 patients (51% male). Average age was 4.5yr (SD=3.7). Out of all rapid molecular GAS tests, 266 (65.7%) were negative, 138 (34.1%) positive and 1 (0.2%) had invalid results. 362 patients (89.4%) also had a throat swab (gold standard test). Comparing the rapid molecular GAS test with throat culture results showed a sensitivity=96.8%, specificity=88.1%, Positive Predictive Value (PPV)= 74% and Negative Predictive Value (NPV)= 98.7%. Out of the 266 children with negative rapid molecular GAS test results, 164 (61.6%) did not receive antibiotic therapy.

Implementation of rapid molecular GAS testing is feasible and practical in a busy ED setting. It can be used to aid rapid decision making at the bedside, meaning appropriate, prompt treatment for GAS without need to follow up on throat culture results – beneficial both for antimicrobial stewardship and patient care.