P-2106. Streamlining Care Delivery in the Pediatric Emergency Department Using Rapid Point-Of-Care Molecular Diagnostics For Group A Streptococcus: A Randomized Controlled Trial
Notice bibliographique
Résumé
Abstract Background As per IDSA guidelines, throat swab testing for group A Streptococcus is important to ensure appropriate antimicrobial use for children with pharyngitis that is not obviously viral. Bacterial culture is the diagnostic reference standard but takes days to result. With culture, physicians often initially provide a prescription that is only to be filled later on if GAS testing is positive. Unfortunately, this strategy can result in inappropriate treatment if parents of children with negative tests fill the script anyway, or if parents of children with positive tests cannot be contacted later. Point-of-care (POC) antigen testing in children is specific but not sensitive, so a negative test still requires culture verification, which limits its overall usefulness. POC molecular GAS testing is as sensitive as culture, and provides a result in minutes, which simplifies prescribing. ED physician satisfaction at enrolment Satisfaction was captured using a 5-point Likert scale on the day of enrolment. Methods A randomized controlled trial was done in a Canadian children’s emergency department (ED). Children aged >3 y with throat swabs ordered to diagnose GAS pharyngitis were eligible. Participants were randomized 1:1 to either the IDNOW Strep A2 (intervention) or bacterial culture (control). The primary outcome was appropriate treatment, ie taking antibiotics if GAS-positive or not taking antibiotics if GAS-negative. Secondary outcomes included physician and parent satisfaction and time to symptom resolution. Caregiver satisfaction at enrolment Satisfaction was captured using a 5-point Likert scale on the day of enrolment. Results 392 participants were recruited from Jan 2021 – Mar 2024. Intervention and control groups were similar in terms of mean age (8.2 vs 8.3 y) and mean MacIsaac score (both 3.3); 29% of the intervention group and 41% of the control group were GAS-positive. Participants in the intervention group were significantly more likely to receive appropriate antibiotics (90.8% vs 76.3%, OR 3.1 [95%CI 1.7-5.7], p< 0.001). ED physicians (pOR 147, p< 0.001) and parents (pOR 2.4, p< 0.001) were also much more likely to be satisfied with POC molecular testing. There were no statistically significant differences in time to resolution of symptoms, though comparisons favoured the intervention. Conclusion In the largest RCT of molecular GAS testing yet done, the intervention was associated with substantial improvements in appropriate antibiotic prescribing and was clearly preferred by both ED physicians and parents. Disclosures Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,004 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,017 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».