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

<h4>Background</h4>Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.<h4>Objective</h4>To examine the sensitivity and specificity, and sources of variability, of RAST for...

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Autores principales:	Emily H Stewart, Brian Davis, B Lee Clemans-Taylor, Benjamin Littenberg, Carlos A Estrada, Robert M Centor
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3c66134ba9544b7c85d6a84fcf79df5d
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spelling	oai:doaj.org-article:3c66134ba9544b7c85d6a84fcf79df5d2021-11-25T05:54:42ZRapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0111727https://doaj.org/article/3c66134ba9544b7c85d6a84fcf79df5d2014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0111727https://doaj.org/toc/1932-6203<h4>Background</h4>Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.<h4>Objective</h4>To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.<h4>Data sources</h4>MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000-2012.<h4>Study selection</h4>Culture as reference standard, all languages.<h4>Data extraction and synthesis</h4>Study characteristics, quality.<h4>Main outcome(s) and measure(s)</h4>Sensitivity, specificity.<h4>Results</h4>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%).<h4>Conclusions</h4>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.Emily H StewartBrian DavisB Lee Clemans-TaylorBenjamin LittenbergCarlos A EstradaRobert M CentorPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 11, p e111727 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Emily H Stewart Brian Davis B Lee Clemans-Taylor Benjamin Littenberg Carlos A Estrada Robert M Centor Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.
description	<h4>Background</h4>Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach.<h4>Objective</h4>To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis.<h4>Data sources</h4>MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000-2012.<h4>Study selection</h4>Culture as reference standard, all languages.<h4>Data extraction and synthesis</h4>Study characteristics, quality.<h4>Main outcome(s) and measure(s)</h4>Sensitivity, specificity.<h4>Results</h4>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%).<h4>Conclusions</h4>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.
format	article
author	Emily H Stewart Brian Davis B Lee Clemans-Taylor Benjamin Littenberg Carlos A Estrada Robert M Centor
author_facet	Emily H Stewart Brian Davis B Lee Clemans-Taylor Benjamin Littenberg Carlos A Estrada Robert M Centor
author_sort	Emily H Stewart
title	Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.
title_short	Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.
title_full	Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.
title_fullStr	Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.
title_full_unstemmed	Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.
title_sort	rapid antigen group a streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/3c66134ba9544b7c85d6a84fcf79df5d
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Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis.

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