Clinical prediction of streptococcal pharyngitis at the initial visit is often difficult. The applicability of the gram stain in the initial assessment of streptococcal pharyngitis was evaluated by comparing gram stain with ultimate culture results. Positive gram stains showed polymorphonuclear cells and typical gram-positive cocci. Thirty-one physicians rotating through the Acute Care Clinic of a county teaching hospital participated in the evaluation. The sensitivity, specificity, and predictive value of a positive test (PVP) were 62 per cent, 70 per cent, and 47 per cent, respectively. These results were compared to a clinical algorithm and to the results of a group with more expertise in the technique. It is concluded that the gram-stained smear of pharyngeal secretions does not appear to be a practical tool for the diagnosis of streptococcal pharyngitis in a busy pediatric emergency unit of a teaching hospital.
Get full access to this article
View all access options for this article.
References
1.
Bisno ALThe diagnosis of streptococcal pharyngitis. Ann Intern Med1979;90:426-8.
2.
Monto AS, Ullman BMAcute respiratory illness in an American community: the Tecumseh study. JAMA1974;227:164-9.
3.
Peter G., Smith ALGroup A streptococcal infections of the skin and pharynx. N Engl J Med1977;297:365-70.
4.
Rowe RT, Stone RTStreptococcal pharyngitis in children: difficulties in diagnosis on clinical grounds alone. Clin Pediatr1977;16:933-5.
5.
Stillerman M. , Bernstein SHStreptococcal pharyngitis: evaluation of clinical syndromes in diagnosis. Am J Dis Child1961 ;101:476-89.
6.
Tomkins RK, Burnes DC, Cable WEAn analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever presentation. Ann Intern Med1977;86:481-92.
7.
Rauch HC, Ranatz LAImmunofluorescent identification of group A streptococci in direct throat smears. J Lab Clin Med1963;61:529-36.
8.
Ayoub EM, Wannamaker LWIdentification of group A streptococci: evaluation of the use of the fluorescent-antibody technique. JAMA1964;187:908-13.
9.
Crawford G., Brancato F., Holmes KKStreptococcal pharyngitis: diagnosis by gram stain. Ann Intern Med1979;90:293-7.
10.
Moody MDOld and new techniques for rapid identification of Group A streptococci. In: Wannamaker LW, Matsen JM, eds. Streptococci and streptococcal diseases . New York: Academic Press, 1972:183.
11.
Leaverton PEA review of biostatistics. A program for self-instruction. Boston: Little, Brown & Co, 1978:44-50.
12.
Breese BBA simple scorecard for the tentative diagnosis of streptococcal pharyngitis . Am J Dis Child1977; 131:514-7.
13.
Walsh BT, Bookheim WW, Johnson RC, Tomkins RKRecognition of streptococcal pharyngitis in adults. Arch Intern Med1975;134:1493-7.
14.
Kaplan EL, Top FH Jr, Dudding BA, Wannamaker LW. Diagnosis of streptococcal pharyngitis: differentiation of active infection from carrier state in the symptomatic child. J Infect Dis1971;123:490-501.
