PC1224: Improving Strep Pharyngitis Diagnosis and Treatment in the Emergency Department of a Community Hospital

Purpose/Objectives: Our first objective is to improve strep pharyngitis testing, including rapid strep test (RST) and throat culture utilization, in the emergency department of a community hospital in Ontario, Canada. Our second objective is to improve the treatment of confirmed strep pharyngitis, including antibiotic choice and dosage.

Design/Methods: We obtained data from the emergency department of all pediatric cases (ages 0 -14) on which an RST was performed in November and December 2021. We performed a chart review data to decide if the RST done followed either the IDSA guidelines or Centor criteria. We also reviewed whether a throat culture followed a negative RST. Finally, we reviewed the antibiotic and dosage prescribed for positive cases.

Results: Over November and December 2021, there was a total of 96 children who had an RST in the emergency department. Only 8 children (8.33%) met either the IDSA or Centor criteria for testing. Most children did not meet testing criteria due to age less than 3 years (53%). 40 children (41.67%) had a positive RST, and 56 (58.33%) children had a negative RST. Out of those with a negative RST, only 37.5% had a throat culture performed. Out of children with a positive RST, 90% received antibiotic therapy, mostly amoxicillin (70%). The dosage (in mg/kg/day) of amoxicillin ranged between 23 – 100, with an average of 58 and a SD of 21. Out of the patients who did not receive amoxicillin, none of them had a documented allergic reaction to penicillin.

Conclusion/Discussion: We utilized 2 different criteria for deciding whether a child meets the testing criteria for strep pharyngitis. The IDSA guidelines and Centor criteria. Our review revealed that most children tested did not meet either of these criteria. Given that RST has a sensitivity of 70%, it is recommended that children with a negative RST have a throat culture performed. The findings of our review revealed that most children do not have a follow-up culture done. Finally, our review revealed that not all children diagnosed with strep pharyngitis are receiving the recommended treatment and dosage, which is either Penicillin or Amoxicillin unless there is documented hypersensitivity to penicillin.

To improve testing and treatment, we performed 3 interventions in March 2022: 1. We met with our emergency department’s colleagues to educate them about testing criteria and recommended treatment. 2. We printed educational pamphlets about streptococcal pharyngitis and displayed them in different sections of the emergency department. 3. We implemented a warning sign that pops up on the electronic medical record when someone orders an RST to be done on a child less than 3 years old.

We will collect data from April and May 2022 to compare our results post-intervention.