Thursday, January 23, 2014

More than 230,000 unnecessary doctor visits a year could be prevented if an experimental strep throat test becomes a reality. 

More than 12 million Americans go to the doctor complaining of a sore throat each year, many expecting to get antibiotics for a strep throat infection. Yet a majority of these cases are caused by viruses like the common cold and will get better on their own without a prescription. Those caused by the bacteria group A streptococcus, commonly known as strep throat, do need antibiotics for treatment. 

Researchers from Boston Children's Hospital and the University of California, San Diego, School of Medicine have devised a simple way to assess whether or not you have strep throat using an over-the-phone assessment of symptoms along with real-time rates of infection with the strep throat bacteria in your community. Evaluating this information could let you know your likelihood of having strep and whether or not you need to go to the doctor.

By asking two questions -- do you have a cough and have you had a fever in the last 24 hours-- people at home could easily know whether or not it's worth making a doctor's appointment.

Symptoms of strep throat include sore throat, headache, fever, and sometimes vomiting. But if your sore throat comes with just nasal congestion and a cough, it's more likely to be caused by a virus.

To validate the accuracy of this concept, researchers analyzed information from 71,776 people age 15 and over who visited CVS Minute Clinics in six states for a sore throat between 2006 and 2008. They took into account the patients' symptoms and strep test results to determine their findings. 

Then they calculated what the benefits would be for people who go to the doctor in any given year for a strep throat evaluation. Almost a quarter of a million people would likely be able to estimate that their chance of strep throat was less than 10 percent and save themselves a doctor visit.  

Experts are concerned about whether or not this test would actually work. “Doctors should be the ones who are making the decision whether or not to give antibiotics,” said pediatrician Heather Lubell, MD, of St. Christopher's Hospital for Children in Philadelphia. “I’m afraid the test will miss too many.”

However, the health risks of missing a case of strep throat is much lower for people over age 15, the age group looked at in the study. In general, adults usually get better from strep throat on their own within about a week. Treatment with antibiotics is recommended to prevent the infection from spreading to others as well as to reduce the rare but serious risk of rheumatic fever (a disease that can affect the heart and other organs) or kidney complications.

Among children, complications of strep throat are more common and can include ear infections, sinus infections and scarlet fever.

Dr. Lubell said the idea of doing more at home testing to prevent unnecessary office visits and medication is interesting, but, “I worry about this one in particular.”

One current limitation with the at-home assessment is that the other component -- real-time infection rates for the strep bacteria -- are not currently available in most areas of the United States. 

“I don’t think it’s very practical at all,” said Lubell. “At any given time, I don’t know what’s going on in the community with strep.”

Still, according to the researchers, most hospitals and large group physician practices may already have enough information to generate their own real-time surveillance data.

Although Lubell said she gets a lot of parents who ask for strep tests for their children, she doesn’t think it’s enough that it would justify the costs versus benefits of maintaining a strep infection database. Lubell added that most pediatrician and primary care physician offices already ask people who call in with sore throat concerns the same questions about symptoms recommended by the at-home strep test.

“If you have good people answering the phones they should be asking these questions anyway so we know if patients need to come in or not,” Lubell said.