Spectrum bias of a rapid antigen detection test for group A β-hemolytic streptococcal pharyngitis in a pediatric population
Spectrum bias of a rapid antigen detection test for group A β-hemolytic streptococcal pharyngitis in a pediatric population
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DOI：
10.1542/peds.114.1.182
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发表时间：
2004-07-01
期刊：
影响因子：
8
通讯作者：
Belongia, EA
中科院分区：
文献类型：
--
作者：
Hall, MC;Kieke, B;Belongia, EA
背景快速抗原检测试验（RADT）通常用于儿童A组β-溶血性链球菌（GABHS）咽炎的诊断。在成年人中，该测试的灵敏度根据疾病的严重程度而变化（谱偏倚）。当该试验用于儿科人群时，可能会发生类似的现象，这可能会影响对所有阴性RADT结果进行培养确认的需要。为了评估临床评分系统的性能，并确定是否RADT频谱偏差是存在于儿童谁是GABHS咽炎评估。回顾性分析了2002年1月至2002年3月在马什菲尔德诊所接受RADT的连续系列儿科患者的实验室和临床记录。采用改良的Centor标准，即发热史、无咳嗽、咽部渗出物和颈部淋巴结病，根据临床特征的数量对患者进行分层。RADT的敏感性定义为RADT结果阳性的患者数除以RADT结果阳性或RADT结果阴性但咽喉培养结果阳性的患者数。561名儿童中有117名（21%）的RADT结果呈阳性，444名RADT结果阴性的儿童中有35名（8%）的培养结果呈阳性。GABHS咽炎的总体患病率为27%（95%置信区间：23-31%）。GABHS咽炎的患病率在0 Centor标准的患者中为18%，在1个标准的患者中为16%，在2个标准的患者中为32%，在3或4个标准的患者中为50%。频谱偏倚是存在的，因为随着Centor评分的增加，RADT敏感性增加，即在Centor评分为0的儿童中，敏感性为47%，在1个标准的儿童中，敏感性为65%，在2个标准的儿童中，敏感性为82%，在3或4个标准的儿童中，敏感性为90%。RADT对GABHS咽炎的敏感性不是一个固定值，而是随着疾病的严重程度而变化。然而，即使在GABHS咽炎的Centor标准大于或等于3的儿科患者中，RADT的敏感性仍然太低，不支持在没有培养确认阴性结果的情况下使用RADT。
Background. Rapid antigen detection testing (RADT) is often performed for diagnosis of group A beta-hemolytic streptococcal (GABHS) pharyngitis among children. Among adults, the sensitivity of this test varies on the basis of disease severity (spectrum bias). A similar phenomenon may occur when this test is used in a pediatric population, which may affect the need for culture confirmation of all negative RADT results.Objectives. To assess the performance of a clinical scoring system and to determine whether RADT spectrum bias is present among children who are evaluated for GABHS pharyngitis.Methods. Laboratory and clinical records for a consecutive series of pediatric patients who underwent RADT at the Marshfield Clinic between January 2002 and March 2002 were reviewed retrospectively. Patients were stratified according to the number of clinical features present by using modified Centor criteria, ie, history of fever, absence of cough, presence of pharyngeal exudates, and cervical lymphadenopathy. The sensitivity of the RADT was defined as the number of patients with positive RADT results divided by the number of patients with either positive RADT results or negative RADT results but positive throat culture results.Results. RADT results were positive for 117 of 561 children (21%), and culture results were positive for 35 of 444 children (8%) with negative RADT results. The overall prevalence of GABHS pharyngitis was 27% (95% confidence interval: 23-31%). The prevalence of GABHS pharyngitis was 18% among patients with 0 Centor criteria, 16% among those with 1 criterion, 32% among those with 2 criteria, and 50% among those with 3 or 4 criteria. Spectrum bias was present, inasmuch as RADT sensitivity increased with Centor scores, ie, 47% sensitivity among children with 0 Centor criteria, 65% among those with 1 criterion, 82% among those with 2 criteria, and 90% among those with 3 or 4 criteria.Conclusions. The sensitivity of RADT for GABHS pharyngitis is not a fixed value but varies with the severity of disease. However, even among pediatric patients with greater than or equal to3 Centor criteria for GABHS pharyngitis, the sensitivity of RADT is still too low to support the use of RADT without culture confirmation of negative results.