2135 Cooking on GAS: implementing guidelines for suspected Group A streptococcus in the emergency department at royal Aberdeen childrens hospital

Conclusion 21 BTS were sent in the 2 months pre-guideline (October – December 2022), and 137 BTS were sent in the 6 months post-guideline (December 2022 – June 2023). GAS positivity was 38.1% versus 33.6% respectively. Rates of GAS-positive patients receiving antibiotics on discharge decreased from 100.0% to 69.6% (p=0.077); all GAS-positive patients not given antibiotics on discharge were prescribed antibiotics after swab result. GAS-negative patients receiving antibiotics fell from 69.2% to 57.1% (p=0.543). FeverPAIN ≥4 had a PPV of 50% pre-guideline, whilst the post-guideline revised treatment threshold FeverPAIN ≥3 had PPV of 41.1%. Whilst demonstrating good guideline adherence and targeted antibiotic prescribing post guideline introduction, this didn’t improve the correct identification and treatment of GAS. The FeverPAIN score PPV was low, meaning there were children who could have come to harm had BTS not been sent and results acted upon. This suggests reduced reliability of FeverPAIN scoring. With future spikes in GAS cases likely, further research needs to be done to correctly target antibiotic prescribing for GAS pharyngitis. References Martin JM, Green M. Group A streptococcus. Semin Pediatr Infect Dis. 2006;17(3):140-8. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021;12(12):CD000023. Dooling KL, Shapiro DJ, Van Beneden C, Hersh AL, Hicks LA. Overpresc...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: APEM Elizabeth Molyneux Prize Papers Source Type: research