Strep test at home?

strepA scoring test done at home could help doctors decide whether a person’s sore throat warrants an office visit, according to a study in the Annals of Internal Medicine.

According to the authors of the study, their scoring test could prevent as many as 230,000 unnecessary visits to the doctor every year. But two editorials accompanying the study argued that the test isn’t practical or cost-saving.

In the United States, more than 12 million people go to the doctor because of a sore throat each year, according to background information in the study. Most sore throats are caused by viruses and go away on their own after a few days. But some—like strep throat—are caused by bacterial infections, which often need to be treated with antibiotics.

The current consensus of medical groups, including the American College of Physicians and Centers for Disease Control and Prevention, is not to test or treat adults who are at low risk for strep throat, the authors noted. But deciding who is at low risk versus who needs to be tested or treated for strep has long vexed doctors, according to both the study and the editorials.

“Answering these questions would not only improve care but probably save valuable resources,” noted one of the editorials.

That’s why researchers developed this scoring system.

About the study

Researchers looked at the medical records of 71,776 people who had visited a chain of health clinics over about a two-year period, complaining of a sore throat or having symptoms suggestive of strep throat.

The authors considered strep throat to be confirmed if the patient had a positive throat culture or streptococcal DNA probe.

They then determined variables that could help measure the likelihood of a person having strep throat before coming in for an office visit. These included symptoms like pain when swallowing, fever, headache and absence of cough. Other variables included the person’s medical history, age and whether strep throat was prevalent in the community at the time.

The researchers then developed a mathematical scoring system that assessed the risk of strep, and they applied the math to the patients’ medical records.

They found that their scoring system accurately predicted which cases would be confirmed as strep throat and which ones would not.

Doctors could use the scoring system over the phone or online to assess which patients did or did not need an in-office evaluation, the authors wrote. Those people deemed at low risk could be advised to take certain measures and recheck their scores in 24 or 48 hours. People whose scores put them at high risk for strep would be seen by a doctor.

Although both editorials applauded the researchers’ goals, they concluded that the scoring test had a number of flaws that made it impractical.

The take-home message
Lab tests are currently the only way to confirm strep throat, and the debate over the usefulness of the in-home strep test suggests that isn’t likely to change in the near future.

 

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