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My thanks to all of my friends and colleagues who answered my little
survey. We've been toying with this for awhile and much of what you told
me was quite helpful. As many of you know the newer technology rapid strep
tests compare favorably with cultures performed in office settings. This
means that office based docs who perform and incubate their own culture
are just as well off with a rapid strep and no culture. Unfortunately,
when rapid streps are compared to hospital based "reference lab" cultures
they don't fare as well. They are about 80 to 90% as sensitive as
reference lab cultures presumably because the hospital labs are able to
use some techniques to amplify the production of hemolysins. This places
us in a bit of a quandry.
 
We all know that clinical judgement is about as good as flipping coins for
exudative pharyngitis.
 
Culture is the most accurate method but involves administrative time in
follow up.
 
Presumptive treatment exacerbates the growing problem of microbial
resistance.
 
Rapid strep is convenient but doesn't eliminate many cultures and is more
expensive than culture (I'm talking actual costs here, not charges)
 
The results:
 
Of 17 respondants 14 institutions use the rapid strep.
All 14 send cultures to the lab when the rapid strep is negative.
 
Some hospitals do the reagent testing in the ED (in one case it is done at
triage!!!) while others send the sample to the lab for reagent testing
later (usually in batches at fixed times).
 
Thanks again.
 
BK
 
Brent R King, M.D.
St. Christopher's Hospital for Children
 
"... And Crispin Crispian shall ne'er go by,
from this day to the ending of the world,
But we in it shall be remembered;
We few, we happy few, we band of brothers..."
                                       Henry V - Wm Shakespeare
 
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