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Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.

Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM - PLoS ONE (2014)

Bottom Line: Sensitivity, specificity.We could not identify sources of variability among higher quality studies.The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.

View Article: PubMed Central - PubMed

Affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America.

ABSTRACT

Background: Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.

Objective: To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.

Data sources: MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000-2012.

Study selection: Culture as reference standard, all languages.

Data extraction and synthesis: Study characteristics, quality.

Main outcome(s) and measure(s): Sensitivity, specificity.

Results: We included 59 studies encompassing 55,766 patients. Forty three studies (18,464 patients) fulfilled the higher quality definition (at least 50 patients, prospective data collection, and no significant biases) and 16 (35,634 patients) did not. For the higher quality immunochromatographic methods in children (10,325 patients), heterogeneity was high for sensitivity (inconsistency [I(2)] 88%) and specificity (I(2) 86%). For enzyme immunoassay in children (342 patients), the pooled sensitivity was 86% (95% CI, 79-92%) and the pooled specificity was 92% (95% CI, 88-95%). For the higher quality immunochromatographic methods in the adult population (1,216 patients), the pooled sensitivity was 91% (95% CI, 87 to 94%) and the pooled specificity was 93% (95% CI, 92 to 95%); however, heterogeneity was modest for sensitivity (I(2) 61%) and specificity (I(2) 72%). For enzyme immunoassay in the adult population (333 patients), the pooled sensitivity was 86% (95% CI, 81-91%) and the pooled specificity was 97% (95% CI, 96 to 99%); however, heterogeneity was high for sensitivity and specificity (both, I(2) 88%).

Conclusions: RAST immunochromatographic methods appear to be very sensitive and highly specific to diagnose group A streptococcal pharyngitis among adults but not in children. We could not identify sources of variability among higher quality studies. The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.

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Related in: MedlinePlus

PRISMA Flow Diagram.
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pone-0111727-g001: PRISMA Flow Diagram.

Mentions: Figure 1 displays the overall summary of the evidence search; we could not retrieve three studies for full article review [21]–[23]. Our searches identified all 24 studies included in the systematic review published in Spanish [7]. We included 58 studies that examined 55,766 patients [24]–[81]. One study [28] utilized two designs, hence 59 studies are mentioned in the rest of the manuscript. The overall prevalence of GAS infection was 28.2% (15,254/54,098 patients) (range 3.7% to 66.6%); we did not include one study [28] in the prevalence calculation as only patients with positive cultures were reported (n = 1,688).


Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.

Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM - PLoS ONE (2014)

PRISMA Flow Diagram.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4219770&req=5

pone-0111727-g001: PRISMA Flow Diagram.
Mentions: Figure 1 displays the overall summary of the evidence search; we could not retrieve three studies for full article review [21]–[23]. Our searches identified all 24 studies included in the systematic review published in Spanish [7]. We included 58 studies that examined 55,766 patients [24]–[81]. One study [28] utilized two designs, hence 59 studies are mentioned in the rest of the manuscript. The overall prevalence of GAS infection was 28.2% (15,254/54,098 patients) (range 3.7% to 66.6%); we did not include one study [28] in the prevalence calculation as only patients with positive cultures were reported (n = 1,688).

Bottom Line: Sensitivity, specificity.We could not identify sources of variability among higher quality studies.The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.

View Article: PubMed Central - PubMed

Affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America.

ABSTRACT

Background: Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.

Objective: To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.

Data sources: MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000-2012.

Study selection: Culture as reference standard, all languages.

Data extraction and synthesis: Study characteristics, quality.

Main outcome(s) and measure(s): Sensitivity, specificity.

Results: We included 59 studies encompassing 55,766 patients. Forty three studies (18,464 patients) fulfilled the higher quality definition (at least 50 patients, prospective data collection, and no significant biases) and 16 (35,634 patients) did not. For the higher quality immunochromatographic methods in children (10,325 patients), heterogeneity was high for sensitivity (inconsistency [I(2)] 88%) and specificity (I(2) 86%). For enzyme immunoassay in children (342 patients), the pooled sensitivity was 86% (95% CI, 79-92%) and the pooled specificity was 92% (95% CI, 88-95%). For the higher quality immunochromatographic methods in the adult population (1,216 patients), the pooled sensitivity was 91% (95% CI, 87 to 94%) and the pooled specificity was 93% (95% CI, 92 to 95%); however, heterogeneity was modest for sensitivity (I(2) 61%) and specificity (I(2) 72%). For enzyme immunoassay in the adult population (333 patients), the pooled sensitivity was 86% (95% CI, 81-91%) and the pooled specificity was 97% (95% CI, 96 to 99%); however, heterogeneity was high for sensitivity and specificity (both, I(2) 88%).

Conclusions: RAST immunochromatographic methods appear to be very sensitive and highly specific to diagnose group A streptococcal pharyngitis among adults but not in children. We could not identify sources of variability among higher quality studies. The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.

Show MeSH
Related in: MedlinePlus