offering strep tests to every pediatric patient c/o sore throat

[TWR]

Should a strep test be offered to every peds patient c/o sore throat? Shouldn't the hx and exam dictate that call? Historically 85% of strep tests are neg.

[ventana]

No no no

[GeneValgene]

No no no

 

haha theoretically no...they always talk about using the centor criteria to determine whether you should test or not...

 

but i have been in multiple practices where they swab everything...just the way things are i guess :)

[MMiller]

I swab just about everybody, just because it makes it easier to tell the parents that it's viral and they don't need antibiotics.

[TWR]

I agree that it takes the wind out of a parents sails about antibiotic or not but is it ethical? Some insurance company is paying for it. I prefer to rely on exam, hx, and my gut!

[Joelseff]

Centor FTW

[ventana]

no exudate, no cervical LAD, no fever, no soft palate petchia - NO swab

 

with less then two of the above - NO swab

 

if around immunocompromised then consider it - also if Hx of valvular heart ds should swab or culture or hx of RF or sickly

 

for the healthy well person coming off the street with a "cold" JUST SAY NOOOOOOOO

[rcdavis]

no exudate, no cervical LAD, no fever, no soft palate petchia - NO swab

 

with less then two of the above - NO swab

 

if around immunocompromised then consider it - also if Hx of valvular heart ds should swab or culture or hx of RF or sickly

 

for the healthy well person coming off the street with a "cold" JUST SAY NOOOOOOOO

 

^^^^

 

This is most excellent advice.

[HopefulPA]

Unfortunately that is not how some practices run. At both my FP and peds clinical rotations every kid with a sore throat, ear ache left with a script for augmentin (and no instructions of wait and see before filling) The FP rarely did the swap and the peds office swap was done for all sore throats but even if neg a script was given. Even when I presented Evidence based info both said yea they knew that but they felt had to CYA for the rare false neg..... :-(

[Febrifuge]

Centor criteria have good negative predictive value, but for me (urgent care, affluent suburb), parents tend to insist, and/or the nurses just swab whomever they feel like. I would be more hardline about it, but I've had a few come back positive on culture whom I would not have swabbed, let alone that they were negative on rapid and I gave my speech about abx. It's pretty much a "damned if you do, damned if you don't" scenario here.

[doubledown10]

This is pretty much the standard of practice wherever I have worked.

no exudate, no cervical LAD, no fever, no soft palate petchia - NO swab

 

with less then two of the above - NO swab

 

if around immunocompromised then consider it - also if Hx of valvular heart ds should swab or culture or hx of RF or sickly

 

for the healthy well person coming off the street with a "cold" JUST SAY NOOOOOOOO

[sk732]

I've had really bad luck with rapid streps - roughly 90+% negative, even had a blatant scarlet fever that was negative...if it looked good but negative, I cultured them...strep will give a positive growth usually within 24 hours, so if it's one of the in betweens, wait out for a bit - it won't hurt them (figuratively). As for folks giving out amoxi-clav for sore throats, no freaking wonder everyone and their uncle seems allergic to amoxicillin - if you're going to give a penicillin, give pen v, since you don't tend to get those drug induced viral exanthems with it like amoxi or ampicillin. I give Pen at a double dose bid to make it easier to take/give. I never give kids amoxicillin for something that might have mono or other virus under/overlaying it - just sets you up for problems. I make use of the sore throat score...and always advise them to come back if things get worse or there isn't any change in a few days. The other option is a CBC...which for most folks is a little unreasonable, but it is there.

 

$0.02

 

SK

[sailordeac]

Still a student...I'm doing my peds rotation right now. Usually if a pt comes in c/o sore throat, the nurses will just go ahead and do the swab. I agree that they really shouldn't be swabbing everyone, but this particular office is always super busy. It just seems to make things flow better and it saves you a little bit of time during the visit trying to persuade mom that it is viral and there's no reason to swab.

 

One tip I've learned from the pediatrician I'm working with, though: he recommends ALWAYS doing a quick look at the ears and throat, no matter what the pt comes in for (even if they're just there for something like suture removal). Once in a while, you may pick up an otitis or strep that's not symptomatic yet (we had a kid the other week that was strep+ but didn't have a fever or any other sx yet).

[ventana]

asymptomatic carriers of strep SHOULD NOT BE TREATED unless their is compelling reason - ie valve Ds, sickly, immunocomp, cancer.....

 

in private practice there is some desire to test for the reimbursement, the patients expect it, it is easier then always educating, if positive it gives you and easy fast answer. BUT this does not mean it is correct - but I bet you most practices do exactly as you say and until the entire industry changes it is next to impossible to change it as a sole provider....

[Joelseff]

^^^^ this....

[fireguy]

something like 15% of the population are strep carriers and do not have strep throat. No reason to swab if there are no symptoms. Why risk a drug reaction for a non-issue?

[gubernaculum]

I agree with fireguy, but I'm still a student doing his peds rotation. The medical group I'm at factors in cost (insurance doesn't always reimburse, especially for capitation), and we rely on the Centor Criteria.