{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:52:40Z","timestamp":1791093160483,"version":"4.1.0"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,2,1]]},"abstract":"<jats:p>Objective. The sensitivity of a rapid antigen-detection test (RADT) for group A streptococcal (GAS) pharyngitis is critical to whether the test is cost-effective and to whether a confirmatory throat culture is needed. We evaluated a second-generation RADT to determine if its sensitivity varies across the broad clinical spectrum of patients tested for GAS in pediatric outpatient practice.<\/jats:p>\n               <jats:p>Methods. We used laboratory logbooks from a single pediatric clinic to identify 1184 consecutive patient visits at which an RADT was performed. In a blinded chart review, we calculated McIsaac scores to separately estimate the pretest clinical likelihood of GAS pharyngitis for visits at which the RADT result was positive (n = 384) and for visits at which the result proved to be false-negative (n = 65). Positive RADT results were assumed to be true positives, and test sensitivity was estimated by dividing the number of positive results by the sum of positives and false-negatives.<\/jats:p>\n               <jats:p>Results. As the clinical likelihood of GAS increased, there were stepwise increases in RADT sensitivity (from 0.67 to 0.88). Sensitivity was low (0.73; 95% confidence interval [CI]: 0.62\u20130.86) in patients clinically unlikely to have GAS (McIsaac score \u22642) and high (0.94; 95% CI: 0.89\u20130.99) in patients &amp;lt;15 years old who had tonsillar exudate and no cough. False-negative RADT results were associated with lighter growth of GAS than found on specimens obtained from a random sample of clinic patients who had only primary throat cultures ordered.<\/jats:p>\n               <jats:p>Conclusions. For pediatric patients who are clinically unlikely to have GAS pharyngitis, as indicated by a McIsaac score \u22642, the sensitivity of a second-generation RADT may drop below thresholds reported for cost-effectiveness. For children who have tonsillar exudate and no cough, the test may be sensitive enough to meet current pediatric practice guidelines for stand-alone testing.<\/jats:p>","DOI":"10.1542\/peds.2004-0907","type":"journal-article","created":{"date-parts":[[2005,2,1]],"date-time":"2005-02-01T18:18:55Z","timestamp":1107281935000},"page":"280-285","source":"Crossref","is-referenced-by-count":64,"title":["Relationship Between the Clinical Likelihood of Group A Streptococcal Pharyngitis and the Sensitivity of a Rapid Antigen-Detection Test in a Pediatric Practice"],"prefix":"10.1542","volume":"115","author":[{"given":"M. Bruce","family":"Edmonson","sequence":"first","affiliation":[{"name":"From the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn R.","family":"Farwell","sequence":"additional","affiliation":[{"name":"From the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,2,1]]},"reference":[{"key":"2021120819181206800_R1","doi-asserted-by":"crossref","unstructured":"Webb KH. Does culture confirmation of high-sensitivity rapid streptococcal tests make sense? A medical decision analysis. Pediatrics.\u20081998;101(2). Available at: www.pediatrics.org\/cgi\/content\/full\/101\/2\/e2","DOI":"10.1542\/peds.101.2.e2"},{"key":"2021120819181206800_R2","doi-asserted-by":"crossref","unstructured":"Ehrlich JE, Demopoulos BP, Daniel KR Jr, Ricarte MC, Glied S. Cost-effectiveness of treatment options for prevention of rheumatic heart disease from group A streptococcal pharyngitis in a pediatric population. Prev Med.\u20082002;35:250\u2013257","DOI":"10.1006\/pmed.2002.1062"},{"key":"2021120819181206800_R3","unstructured":"American Academy of Pediatrics. Group A streptococcal infections. In: Pickering LK ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:573\u2013584"},{"key":"2021120819181206800_R4","doi-asserted-by":"crossref","unstructured":"Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis.\u20082002;35:113\u2013125","DOI":"10.1086\/340949"},{"key":"2021120819181206800_R5","doi-asserted-by":"crossref","unstructured":"Gerber MA, Tanz RR, Kabat W, et al. Optical immunoassay test for group A beta-hemolytic streptococcal pharyngitis. An office-based, multicenter investigation. JAMA.\u20081997;277:899\u2013903","DOI":"10.1001\/jama.277.11.899"},{"key":"2021120819181206800_R6","doi-asserted-by":"crossref","unstructured":"Fries SM. Diagnosis of group A streptococcal pharyngitis in a private clinic: comparative evaluation of an optical immunoassay method and culture. J Pediatr.\u20081995;126:933\u2013936","DOI":"10.1016\/S0022-3476(95)70213-X"},{"key":"2021120819181206800_R7","doi-asserted-by":"crossref","unstructured":"Pitetti RD, Drenning SD, Wald ER. Evaluation of a new rapid antigen detection kit for group A beta-hemolytic streptococci. Pediatr Emerg Care.\u20081998;14:396\u2013398","DOI":"10.1097\/00006565-199812000-00004"},{"key":"2021120819181206800_R8","doi-asserted-by":"crossref","unstructured":"Roosevelt GE, Kulkarni MS, Shulman ST. Critical evaluation of a CLIA-waived streptococcal antigen detection test in the emergency department. Ann Emerg Med.\u20082001;37:377\u2013381","DOI":"10.1067\/mem.2001.114090"},{"key":"2021120819181206800_R9","doi-asserted-by":"crossref","unstructured":"Schlager TA, Hayden GA, Woods WA, Dudley SM, Hendley JO. Optical immunoassay for rapid detection of group A beta-hemolytic streptococci. Should culture be replaced?Arch Pediatr Adolesc Med.\u20081996;150:245\u2013248","DOI":"10.1001\/archpedi.1996.02170280015002"},{"key":"2021120819181206800_R10","doi-asserted-by":"crossref","unstructured":"Roe M, Kishiyama C, Davidson K, Schaefer L, Todd J. Comparison of BioStar Strep A OIA optical immune assay, Abbott TestPack Plus Strep A, and culture with selective media for diagnosis of group A streptococcal pharyngitis. J Clin Microbiol.\u20081995;33:1551\u20131553","DOI":"10.1128\/jcm.33.6.1551-1553.1995"},{"key":"2021120819181206800_R11","doi-asserted-by":"crossref","unstructured":"Kaltwasser G, Diego J, Welby-Sellenriek PL, Ferrett R, Caparon M, Storch GA. Polymerase chain reaction for Streptococcus pyogenes used to evaluate an optical immunoassay for the detection of group A streptococci in children with pharyngitis. Pediatr Infect Dis J.\u20081997;16:748\u2013753","DOI":"10.1097\/00006454-199708000-00004"},{"key":"2021120819181206800_R12","doi-asserted-by":"crossref","unstructured":"Wegner DL, Witte DL, Schrantz RD. Insensitivity of rapid antigen detection methods and single blood agar plate culture for diagnosing streptococcal pharyngitis. JAMA.\u20081992;267:695\u2013697","DOI":"10.1001\/jama.267.5.695"},{"key":"2021120819181206800_R13","doi-asserted-by":"crossref","unstructured":"Gieseker KE, Mackenzie T, Roe MH, Todd JK. Comparison of two rapid Streptococcus pyogenes diagnostic tests with a rigorous culture standard. Pediatr Infect Dis J.\u20082002;21:922\u2013927","DOI":"10.1097\/00006454-200210000-00007"},{"key":"2021120819181206800_R14","doi-asserted-by":"crossref","unstructured":"DiMatteo L, Lowenstein S, Brimhall B, Reiquam W, Gonzales R. The relationship between the clinical features of pharyngitis and the sensitivity of a rapid antigen test: evidence of spectrum bias. Ann Emerg Med.\u20082001;38:648\u2013652","DOI":"10.1067\/mem.2001.119850"},{"key":"2021120819181206800_R15","doi-asserted-by":"crossref","unstructured":"Gerber MA, Randolph MF, Chanatry J, Wright LL, DeMeo KK, Anderson LR. Antigen detection test for streptococcal pharyngitis: evaluation of sensitivity with respect to true infections. J Pediatr.\u20081986;108:654\u2013658","DOI":"10.1016\/S0022-3476(86)81036-8"},{"key":"2021120819181206800_R16","unstructured":"Dagnelie CF, Bartelink ML, van der GY, Goessens W, de Melker RA. Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice. Br J Gen Pract.\u20081998;48:959\u2013962"},{"key":"2021120819181206800_R17","doi-asserted-by":"crossref","unstructured":"Gieseker KE, Roe MH, Mackenzie T, Todd JK. Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing. Pediatrics.\u20082003;111(6). Available at: www.pediatrics.org\/cgi\/content\/full\/111\/6\/e666","DOI":"10.1542\/peds.111.6.e666"},{"key":"2021120819181206800_R18","doi-asserted-by":"crossref","unstructured":"Mulherin SA, Miller WC. Spectrum bias or spectrum effect? Subgroup variation in diagnostic test evaluation. Ann Intern Med.\u20082002;137:598\u2013602","DOI":"10.7326\/0003-4819-137-7-200210010-00011"},{"key":"2021120819181206800_R19","doi-asserted-by":"crossref","unstructured":"Bell SM, Smith DD. Quantitative throat-swab culture in the diagnosis of streptococcal pharyngitis in children. Lancet.\u20081976;2(7976):62\u201363","DOI":"10.1016\/S0140-6736(76)92284-4"},{"key":"2021120819181206800_R20","unstructured":"Gerber MA. Diagnosis of pharyngitis: methodology of throat culture. In: Shulman ST, ed. Pharyngitis in an Era of Declining Rheumatic Fever. New York, NY: Praeger; 1983:61\u201372"},{"key":"2021120819181206800_R21","doi-asserted-by":"crossref","unstructured":"Veasy LG, Wiedmeier SE, Orsmond GS, et al. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med.\u20081987;316:421\u2013427","DOI":"10.1056\/NEJM198702193160801"},{"key":"2021120819181206800_R22","doi-asserted-by":"crossref","unstructured":"Kuhn S, Davies HD, Katzko G, Jadavji T, Church DL. Evaluation of the Strep A OIA assay versus culture methods: ability to detect different quantities of group A streptococcus. Diagn Microbiol Infect Dis.\u20081999;34:275\u2013280","DOI":"10.1016\/S0732-8893(99)00027-9"},{"key":"2021120819181206800_R23","doi-asserted-by":"crossref","unstructured":"Kurtz B, Kurtz M, Roe M, Todd J. Importance of inoculum size and sampling effect in rapid antigen detection for diagnosis of Streptococcus pyogenes pharyngitis. J Clin Microbiol.\u20082000;38:279\u2013281","DOI":"10.1128\/JCM.38.1.279-281.2000"},{"key":"2021120819181206800_R24","doi-asserted-by":"crossref","unstructured":"Baker DM, Cooper RM, Rhodes C, Weymouth LA, Dalton HP. Superiority of conventional culture technique over rapid detection of group A streptococcus by optical immunoassay. Diag Microbiol Infect Dis.\u20081995;21:61\u201364","DOI":"10.1016\/0732-8893(95)00023-4"},{"key":"2021120819181206800_R25","doi-asserted-by":"crossref","unstructured":"Lieu TA, Fleisher GR, Schwartz JS. Clinical evaluation of a latex agglutination test for streptococcal pharyngitis: performance and impact on treatment rates. Pediatr Infect Dis J.\u20081988;7:847\u2013854","DOI":"10.1097\/00006454-198807120-00003"},{"key":"2021120819181206800_R26","unstructured":"McIsaac WJ, Goel V, To T, Low DE. The validity of a sore throat score in family practice. CMAJ.\u20082000;163:811\u2013815"},{"key":"2021120819181206800_R27","unstructured":"McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ.\u20081998;158:75\u201383"},{"key":"2021120819181206800_R28","doi-asserted-by":"crossref","unstructured":"Brien JH, Bass JW. Streptococcal pharyngitis: optimal site for throat culture. J Pediatr.\u20081985;106:781\u2013783","DOI":"10.1016\/S0022-3476(85)80354-1"},{"key":"2021120819181206800_R29","doi-asserted-by":"crossref","unstructured":"Dale JC, Vetter EA, Contezac JM, Iverson LK, Wollan PC, Cockerill FR III. Evaluation of two rapid antigen assays, BioStar Strep A OIA and Pacific Biotech CARDS O.S., and culture for detection of group A streptococci in throat swabs. J Clin Microbiol.\u20081994;32:2698\u20132701","DOI":"10.1128\/jcm.32.11.2698-2701.1994"},{"key":"2021120819181206800_R30","doi-asserted-by":"crossref","unstructured":"Heiter BJ, Bourbeau PP. Comparison of the Gen-Probe group A streptococcus Direct Test with culture and a rapid streptococcal antigen detection assay for diagnosis of streptococcal pharyngitis. J Clin Microbiol.\u20081993;31:2070\u20132073","DOI":"10.1128\/jcm.31.8.2070-2073.1993"},{"key":"2021120819181206800_R31","doi-asserted-by":"crossref","unstructured":"Harbeck RJ, Teague J, Crossen GR, Maul DM, Childers PL. Novel, rapid optical immunoassay technique for detection of group A streptococci from pharyngeal specimens: comparison with standard culture methods. J Clin Microbiol.\u20081993;31:839\u2013844","DOI":"10.1128\/jcm.31.4.839-844.1993"},{"key":"2021120819181206800_R32","doi-asserted-by":"crossref","unstructured":"Chapin KC, Blake P, Wilson CD. Performance characteristics and utilization of rapid antigen test, DNA probe, and culture for detection of group A streptococci in an acute care clinic. J Clin Microbiol.\u20082002;40:4207\u20134210","DOI":"10.1128\/JCM.40.11.4207-4210.2002"},{"key":"2021120819181206800_R33","unstructured":"Sheeler RD, Houston MS, Radke S, Dale JC, Adamson SC. Accuracy of rapid strep testing in patients who have had recent streptococcal pharyngitis. J Am Board Fam Pract.\u20082002;15:261\u2013265"},{"key":"2021120819181206800_R34","doi-asserted-by":"crossref","unstructured":"Brown LD, Cai TT, DasGupta A. Interval estimation for a binomial proportion. Stat Sci.\u20082003;16:101\u2013133","DOI":"10.1214\/ss\/1009213286"},{"key":"2021120819181206800_R35","doi-asserted-by":"crossref","unstructured":"Bisno AL, Peter GS, Kaplan EL. Diagnosis of strep throat in adults: are clinical criteria really good enough?Clin Infect Dis.\u20082002;35:126\u2013129","DOI":"10.1086\/342056"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/115\/2\/280\/1005565\/zpe00205000280.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/115\/2\/280\/1005565\/zpe00205000280.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T20:07:46Z","timestamp":1638994066000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/115\/2\/280\/67358\/Relationship-Between-the-Clinical-Likelihood-of"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,2,1]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2005,2,1]]},"published-print":{"date-parts":[[2005,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2004-0907","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,2,1]]}}}