In children with pharyngitis, how useful are prediction tools to select whom to perform microbiological tests?Original question was: En menores de 18 años con faringitis, el uso de escalas de predicción clínica, ayuda a seleccionar los pacientes a los que realizar pruebas microbiológicas I clarified the question with the user directly!
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- Answered 4 Oct 2019 Conflict of interest declaration: None In 2018 CADTH published “Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines”  which states” “Limited evidence of variable quality, suggests that the use of a clinical decision rule tool, for initial identification of patients with GA strep infection, may reduce unnecessary testing and inappropriate antibiotic use; however the findings were not always statistically significant. Three guidelines, which did not mention any specific clinical decision rule tool, recommend that if signs and symptoms are suggestive of bacterial infection then further testing should be undertaken. One guideline recommends the use of McIsaac tool to identify patients who warrant further testing. One guideline recommends the use FeverPAIN or Centor to identify patients who are likely to benefit from antibiotic treatment. Findings need to be interpreted in the light of limitations.” Other studies that highlight problems include: "This study demonstrated that relying on signs and symptoms for selectively testing children with pharyngitis is not efficient. We recommend using a RADT in all children with pharyngitis."  and "Rules-based selective testing strategies did not show sufficient diagnostic accuracy in this study population. The relevance of clinical prediction rules for determining which children with pharyngitis should undergo a rapid antigen detection test remains questionable."  References 1) https://www.ncbi.nlm.nih.gov/books/NBK532209/ 2) https://www.ncbi.nlm.nih.gov/pubmed/28235012 3) https://www.ncbi.nlm.nih.gov/pubmed/25487666
- Answered 5 Oct 2019 Conflict of interest declaration: None Good morning, I found these documents that could be helpful for your question: Criterios para la utilización del test rápido para el diagnóstico de faringoamigdalitis estreptocócicas en pediatria https://www.comunidad.madrid/sites/default/files/doc/sanidad/farm/criterios_para_la_utilizacion_del_test_rapido_en_faringoamigdalitis_estreptococica.pdf Documento de Consenso sobre recomendaciones de utilización de técnicas de diagnóstico rápido en Atención Primaria https://www.pediatriaintegral.es/publicacion-2017-01/documento-de-consenso-sobre-recomendaciones-de-utilizacion-de-tecnicas-de-diagnostico-rapido-en-atencion-primaria/ Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis. https://www.ncbi.nlm.nih.gov/pubmed/25201792 Best wishes, Rocio