| Summary: | Early use of antibiotic in acute upper respiratory infections has become
controversy because most are caused by viral infection. Appropriate strategy is
needed todiagnoseacute pharyngitis so antibiotic usage will be more appropriate
and reduce excessive antibiotic usage with all the consequences.This study aim to
do diagnostic test for McIsaacCriteria in diagnosing Group-A β-hemolytic
Streptococcus (GABHS) on children with acute pharyngitis. This was a crosssectional
study, diagnostic test of clinical criteria with throat swabsculture as the
gold standard. The research was conducted August 1
st
, 2011 until February 6
th
,
2012 on children 3-14 years oldatpediatric outpatient clinic and emergency wardat
Sanglah Public Hospital and pediatric outpatient clinic at WangayaHospital.
Five hundred and fifty cases with acute pharyngitis during the study
period, 313 of them 3-14 years old, 199 children were excluded due to history of
antibiotics in two weeks, 114 children who meet the inclusion and exclusion
criteria are involved. GABHS prevalence in this study are 7.9%. McIsaac�s Area
Under the Curve (AUC) from Receiver Operating Characteristic (ROC) curve is
78.1% with P = 0.005 (95% CI 60.3% to 96%). The optimal ROC cutoff for
McIsaacscoreis greater than or equal to 4 which has 66.7%(95% CI 49% to 97%)
of sensitivity, 87.6% (CI 95% 81% to 94%) of specificity, 31.6% (CI 95 % 11%
to 52%) of positive predictive value (PPV), 96.8% (95% CI 93% to 100%)of
negative predictive value (NPV),86.0%of accuracy, positive likelihood ratio
(LR+) is 5.4 (95% CI 2.7 to 10.7) and negative likelihood ratio (LR-) is 0.4 (95%
CI 0.2 to 0.9).
McIsaac Criteria total scoreofless than four is favorable to
exclude GABHS pharygitis diagnosis. Total score criteria McIsaac greter than or
equal to four requiresfurther examination toconfirm GABHS pharyngitis.
|
|---|