{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:12:16Z","timestamp":1765728736845,"version":"3.41.2"},"reference-count":11,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Although pharyngitis is common, group A Streptococcus is an uncommon etiology, and sequelae are rare in patients &amp;lt;3 years old. Inappropriate testing leads to increased cost of health care and unnecessary exposure to antibiotics. Rapid streptococcal tests (RSTs) for group A Streptococcus pharyngitis are not routinely indicated in this age group. At our urban, tertiary pediatric emergency department (ED), on average, 20 RSTs were performed each month for patients &amp;lt;3 years of age. Our objective was to reduce RSTs in the ED in patients aged &amp;lt;3 years by 50% in 18 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We initiated this project in October 2016 at an urban, tertiary pediatric ED. We surveyed pertinent multidisciplinary stakeholders to identify factors leading to RSTs in children &amp;lt;3 years of age. We conducted multiple interventions and collected weekly data on the number of RSTs in children aged &amp;lt;3 years (outcome measure) and the number of family complaints and return visits for complications of pharyngitis (balancing measure). We used statistical process control for analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>The mean number of RSTs ordered per month in patients aged &amp;lt;3 years declined by 52% in 10 months. The majority of tests during the study phase were ordered by nurse practitioners (62%) for patients aged 25 to 36 months (66%). There has been 1 family grievance and no patient complications attributable to the project.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Our interventions led to a successful and sustained reduction of RSTs in patients aged &amp;lt;3 years. A local clinical practice guideline was developed, and the project was expanded to other acute care settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2019-0174","type":"journal-article","created":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T12:25:12Z","timestamp":1568204712000},"source":"Crossref","is-referenced-by-count":6,"title":["Reducing Streptococcal Testing in Patients &amp;lt;3 Years Old in an Emergency Department"],"prefix":"10.1542","volume":"144","author":[{"given":"Tania","family":"Ahluwalia","sequence":"first","affiliation":[{"name":"aChildren\u2019s Mercy Hospital, Kansas City, Missouri; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shobhit","family":"Jain","sequence":"additional","affiliation":[{"name":"aChildren\u2019s Mercy Hospital, Kansas City, Missouri; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Norton","sequence":"additional","affiliation":[{"name":"bDivision of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Meade","sequence":"additional","affiliation":[{"name":"aChildren\u2019s Mercy Hospital, Kansas City, Missouri; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Etherton-Still","sequence":"additional","affiliation":[{"name":"aChildren\u2019s Mercy Hospital, Kansas City, Missouri; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Myers","sequence":"additional","affiliation":[{"name":"aChildren\u2019s Mercy Hospital, Kansas City, Missouri; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"issue":"5","key":"2025062311022109000_B1","doi-asserted-by":"crossref","first-page":"e20163403","DOI":"10.1542\/peds.2016-3403","article-title":"Viral features and testing for streptococcal pharyngitis","volume":"139","author":"Shapiro","year":"2017","journal-title":"Pediatrics"},{"issue":"2","key":"2025062311022109000_B2","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1542\/peds.2007-0484","article-title":"Burden and economic cost of group A streptococcal pharyngitis","volume":"121","author":"Pfoh","year":"2008","journal-title":"Pediatrics"},{"issue":"3","key":"2025062311022109000_B3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2009-2648","article-title":"Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis","volume":"126","author":"Shaikh","year":"2010","journal-title":"Pediatrics"},{"key":"2025062311022109000_B4","unstructured":"Centers for Disease Control and Prevention\n          . Group A Streptococcal (GAS) disease. 2016. Available at: https:\/\/www.cdc.gov\/groupastrep\/diseases-hcp\/strep-throat.html. Accessed November 1, 2016"},{"issue":"10","key":"2025062311022109000_B5","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/cid\/cis847","article-title":"Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2014;58(10):1496]","volume":"55","author":"Shulman","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"1","key":"2025062311022109000_B6","doi-asserted-by":"crossref","first-page":"e20172033","DOI":"10.1542\/peds.2017-2033","article-title":"Improving guideline-based streptococcal pharyngitis testing: a quality improvement initiative","volume":"142","author":"Norton","year":"2018","journal-title":"Pediatrics"},{"key":"2025062311022109000_B7","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley","year":"2009","edition":"2nd ed"},{"issue":"2","key":"2025062311022109000_B8","first-page":"90","article-title":"Using control charts to assess performance measurement data","volume":"28","author":"Lee","year":"2002","journal-title":"Jt Comm J Qual Improv"},{"issue":"3","key":"2025062311022109000_B9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S1473-3099(13)70294-9","article-title":"Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study","volume":"14","author":"Little","year":"2014","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"2025062311022109000_B10","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/QCO.0b013e328338c46d","article-title":"Risk-benefit analysis of restricting antimicrobial prescribing in children: what do we really know?","volume":"23","author":"Keith","year":"2010","journal-title":"Curr Opin Infect Dis"},{"issue":"22","key":"2025062311022109000_B11","doi-asserted-by":"crossref","first-page":"634","DOI":"10.15585\/mmwr.mm6722a4","article-title":"Update: influenza activity in the United States during the 2017-18 season and composition of the 2018-19 influenza vaccine","volume":"67","author":"Garten","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2019-0174\/1077913\/peds_20190174.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2019-0174\/1077913\/peds_20190174.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T15:02:31Z","timestamp":1750690951000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/144\/4\/e20190174\/38494\/Reducing-Streptococcal-Testing-in-Patients-lt-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,1]]},"references-count":11,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,10,1]]},"published-print":{"date-parts":[[2019,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2019-0174","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"type":"print","value":"0031-4005"},{"type":"electronic","value":"1098-4275"}],"subject":[],"published":{"date-parts":[[2019,10,1]]},"article-number":"e20190174"}}