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 Rapid strep testing in children

Group A Streptococcus (GA Strep) a gram-positive bacteria accounts for a variety of diseases including pharyngitis, as well as other serious complications such as sepsis, skin infections, and rheumatic heart disease among others. In children, pharyngitis is a common condition, which is responsible for most emergency pediatric visits or primary care. While pharyngitis mainly occurs from viral causes, bacteria also represent a significant account of cases ranging between 20% and 40% in children (Banerjee & Ford, 2018). Due to its frequency, the disease presents a significant burden to healthcare at an estimated cost of $224 and $539 million annually in treating children alone (Banerjee & Ford, 2018). The most important consideration in diagnosing pharyngitis is to understand whether the cause is viral or bacterial. This is critical to prevent overuse/misuse of antibiotics, which leads to antibiotic resistance. If the disease cause is viral, no treatment is required only management. On the other hand, a bacterial cause mandates treatment with an antibiotic. Initially, the test used to confirm whether the causative agent is bacterial or viral was is throat culture. however, with a turnaround time of between 18-48 hours, it delays decision making; hence the introduction of the Rapid Strep test, which takes only 20-30 minutes to get the results.  

About Rapid Strep Test

A rapid Strep test is used in healthcare to provide a rapid diagnosis of pharyngitis so that the practitioner can develop an appropriate treatment path. A rapid test is needed because diagnosing GA strep is challenging and maybe easily dismissed as a viral. Or a viral cause dismissed as bacterial. Moreover, practitioners need to make a diagnosis while the patient is still at the hospital as may not be feasible to tell a parent to wait for 48 hours before receiving medication to help the child (Barakat et al., 2019). For instance, the clinical manifestations of the condition include high fever, headache, sore throat, and pain that makes it difficult to swallow. Thus, it requires immediate attention as these symptoms put a child in great distress. The Rapid Strep Test allows practitioners to make faster and accurate decisions then provide appropriate treatment for the child.

The purpose of the Rapid Strep test is to investigate whether the pathogen causing pharyngitis is a bacterium (GA Strep) or virus and provide effective medication depending on the cause. The procedure is conducted by taking a throat swab is taken at the back of the throat and subjected to a rapid antigen test to check for the presence of GAS bacteria (Barakat et al., 2019). The process may result in temporary pain or discomfort to the child that soon goes away. The procedure is simple and may be done in the lab or the doctor's office. The information provided by the test is useful to the doctor to confirm whether an infection requires bacterial treatment. Providing bacterial treatment is important to prevent complications that might occur if the condition remains untreated such as rheumatic fever (Lean et al., 2014). At the same time, the use of antibiotics is challenging because a wrong diagnosis results in misuse, which contributes to the problem of antibiotic resistance. As such, the practitioner cannot simply rely on observable symptoms such as redness of the throat and the presence of tonsils.

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Validity and Reliability of the Tool

Understanding the validity and reliability of a tool is important in determining the accuracy of the results from such a tool. For example, though the Rapid Strep test though is useful in the faster detection of GAS, it is not as reliable as the throat culture test. The ways of understanding the validity and reliability are through evaluation of specificity and sensitivity, specificity, and positive and negative predictive values. Research conducted by Banerjee & Ford (2018) revealed that the sensitivity rate for the instrument was between 82% and 100%. On the other hand, the specificity values ranged from 81-100%. These values for specificity and sensitivity are high indicating the reliability of the Rapid Strep Test. In another research, the authors set to explore false positives in the Rapid Strep test for children recently diagnosed with the presence of GAS (Barakat et al., 2019). The false-positive rate was 11.5% for the experimental group compared to 0 for the control group. Thus, the chances of getting false-positive results are higher in children previously found with GAS within 28 years. This might result in overtreatment with antibiotics leading to antibiotic resistance.  

In a meta-analysis study, Lean et al. (2014) compare sensitivities and specificity reported by 48 studies and report an average sensitivity of 0.86 and an average specificity of 0.96, which stands for 86% and 96% respectfully. Further, given that there are different types of rapid antigen detection tests (RADTs), the research evaluates the specificities and sensitivities of the different types. The results show a range of specificities between 92.5% and 71.6% and specificities, 97.0% and 73.3% (Lean et al., 2014). These results so far indicate high rates of sensitivities and specificities for the instrument. Specificity is the rate at which a test is relevant to a particular condition. Thus, the higher the value of specificity the higher the accuracy of the test. Similarly, sensitivity is the rate at which the test is sensitive to the microorganism such as bacteria being tested for in a procedure. The higher the sensitivity the higher the accuracy of the test outcomes. accurate results prove the reliability and validity of the instrument for detecting the presence of GAS.

Sølvik et al. (2021) also examined the performance of the Rapid Strep Test against other molecular tests that give quick results for GAS. The authors found out that, the tests indicated that the sensitivity and specificity rates were not only high: 92% and 96% respectively, but the test was also user-friendly. As such, the test does not have any complexities that would undermine the results; hence, the reliability of the tool. Nevertheless, in a comparison between throat culture and rapid strep test, an analysis shows that rapid strep test has a high tendency for false-negative meaning that in some significant cases, GAS remains undetected in patients but later detected with a throat culture. The rates of false-positive and false negatives in rapid strep tests are significant to create concern about the effectiveness of the test. Another weakness of the rapid strep test is that it is labor-intensive in that one test is carried out at a time when the patient is waiting. It creates no opportunity to batch testing that might save labor and resources.

Despite the weaknesses, the rapid strep test proves to be a reliable and valid approach to faster detection of GAS in children to provide immediate intervention. while the throat culture test has higher reliability, its major weakness is the long turnaround time, which makes it impossible for the patients to wait for the results before receiving treatment.

 

References

Banerjee, S., & Ford, C. (2018). Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness. CADTH Rapid Response Report: Peer Reviewed Summary with Critical Appraisal.

Barakat, A. J., Evans, C., Gill, M., & Nelson, D. (2019). Rapid strep testing in children with recently treated streptococcal pharyngitis. Pediatr Investig, 3(1), 27–30. doi: 10.1002/ped4.12109.

Lean, W. L., Arnup, S., Danchin, M., & Steer, A. (2014). Rapid Diagnostic Tests for Group A Streptococcal Pharyngitis: A Meta-analysis. Pediatrics, 2014-1094. https://doi.org/10.1542/peds.2014-1094.

Sølvik, U., Boija, E., & Ekvall, S. (2021). Performance and user-friendliness of the rapid antigen detection tests QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick for pharyngotonsillitis caused by Streptococcus pyogenes in primary health care. Eur J Clin Microbiol Infect Dis, 40, 549–558. https://doi.org/10.1007/s10096-020-04034-z.

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