Print

Print


> Since the sensitivity and specifity of combined Rapid strep and culture
> is quite high, and the prevalence of the disease among the select
> population (children greater than 5 with sorethroats) is also high, then the
> positive predictive value should be high. Very few cases will be missed and
> less needless abx will be prescribed which is of clear benefit to the public.
> My understanding is that the 1-2 day delay in treatment while waiting for
> the culture does not increase the risk of ARF.
>
> I can think of no argument to justify treating everyone, unless your
> department refuses to do rapid streps and cannot do follow-up on patients
> for socioeconmic reasions.
>
Here we go again, speaking in vague terms.
 
"... the positive predictive value should be high."
How high?
 
"Very few cases will be missed ..."
How few?
 
" ... and less needless abx will be prescribed"
How much less?
 
" ... which is of clear benefit to the public."
How much benefit?
 
 
My post to the list was not placed to provide the definitive answer to
the question of the proper approach to patients with GABHS.  My analysis
was far too simple (non-rigorous assumptions regarding percentages,
leaving out all of the factors alluded to, etc.). My point was simply
that arguments made with vague statements answer nothing as far as I can
see.
 
Take "very few cases will be missed."  What does that mean?  If we miss
one case per thousand, is that okay or no?  How about one in a million?
One in a billion?
The answer doesn't exist without a cost-benefit analysis.  It's all
arithmetic.
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html