Thanks for clarifying my original question.


Should we even be testing the <2-3 yr old for strep?





-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Seiden, Jeffrey A
Sent: Thursday, June 03, 2010 4:19 PM
To: [log in to unmask]
Subject: Re: Rapid Strep Test < 2 years old


It seems to me that the original question has morphed into something
entirely different.  The issue is not who should be treated for a positive
strep test...the issue is who should be tested.  With carrier rates in
asymptomatic school aged children being quoted up to 20-25% in the
literature, we need to be aware of the increasing rate of false positives
(where positive means the disease state is present, and not just the
bacteria) when the prevalence of disease decreases (as in the youngest
patients).  Of course, there are cases of pathologic GAS in these very young
patients, but if our pre-test probability is low (eg 1 yr old with one day
of fever, runny nose, no rash, etc), the false positive rate is sky-high.
For me, if I send the test and it's positive, I treat.  But more often than
not, I'm not sending the test in patients under 3 yrs old unless there is
something that separates that patient from the numerous others with
straightforward viral symptoms.




Jeff Seiden, MD

Pediatric Emergency Medicine

The Children's Hospital of Philadelphia


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