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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

Adult strata, forest plots for immunochromatographic (top panels), enzyme immunoassay (EIA, middle panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.
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pone-0111727-g005: Adult strata, forest plots for immunochromatographic (top panels), enzyme immunoassay (EIA, middle panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.

Mentions: The prevalence of GAS infection in the 6 adults strata was 21.3% (259/1,216 patients) (range 16.1% to 25.7%). The coupled forest plots for sensitivity and specificity shows modest heterogeneity (I2 = 61% for sensitivity and I2 = 72% for specificity; Figure 5; top panels, Table 1). The pooled sensitivity was 91% (95% CI, 87–94%) and the pooled specificity was 93% (95% CI, 92 to 95%). One outlier study [75] met 12 quality criteria (Table S3 in File S1) and enrolled 100 patients presenting to an emergency room in Istanbul [75]. Another outlier study, [29] met nine quality criteria (Table S3 in File S1) and enrolled 148 patients presenting to two primary care settings in Boston (Massachusetts).


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)

Adult strata, forest plots for immunochromatographic (top panels), enzyme immunoassay (EIA, middle panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0111727-g005: Adult strata, forest plots for immunochromatographic (top panels), enzyme immunoassay (EIA, middle panels) and optical immunoassay (OIA, bottom panels) methods to diagnose group A streptococcal pharyngitis, higher study methodological quality.
Mentions: The prevalence of GAS infection in the 6 adults strata was 21.3% (259/1,216 patients) (range 16.1% to 25.7%). The coupled forest plots for sensitivity and specificity shows modest heterogeneity (I2 = 61% for sensitivity and I2 = 72% for specificity; Figure 5; top panels, Table 1). The pooled sensitivity was 91% (95% CI, 87–94%) and the pooled specificity was 93% (95% CI, 92 to 95%). One outlier study [75] met 12 quality criteria (Table S3 in File S1) and enrolled 100 patients presenting to an emergency room in Istanbul [75]. Another outlier study, [29] met nine quality criteria (Table S3 in File S1) and enrolled 148 patients presenting to two primary care settings in Boston (Massachusetts).

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