6350 Point-of-care testing for group A streptococcal (GAS) pharyngitis in a children’s emergency department during a rise in invasive GAS disease in the UK

Objectives We report on the urgent implementation of point-of-care testing (POCT) for Group A streptococcal infection (GAS) in our emergency department (ED) in response to an increased incidence in life-threatening invasive GAS disease in children and a shortage of antibiotics in the UK, 2022–23.1 Methods Clinicians were advised to use the McIsaac score to screen for likelihood of GAS infection in children with pharyngitis and a score of '3' or greater (3 = 27–28% likelihood of GAS infection) prompted POCT for GAS infection, based on our existing guideline.2 A swab was taken by nursing staff and processed by a satellite laboratory in the ED using Abbott ID NOW™ STREP A 2. Back-up swabs for culture were sent for the first 181 tests to check diagnostic accuracy. For children tested, data was collected on demographics, POCT result, discharge diagnosis and antibiotic prescriptions. Data on all attendances during this period for pharyngitis and similar diagnoses (e.g. upper respiratory tract infection) were collected to estimate how many children were actually tested. Results Between 16th December 2022 to 19th April 2023, 1,388 patients underwent POCT (45% female, 55% male, median age 3 years). McIsaac score was rarely documented and based on presentation, 571 (41%) patients were tested inappropriately (i.e. they did not have pharyngitis or similar infection). For all children coded with pharyngitis and similar presentations in this period (1,484), 45% were not tested using POCT. In children tested, true prevalence of GAS infection was 7% (95%CI 4–12%) and prevalence in children Conclusion Our experience suggests future urgent implementation of POCT should focus on clear communication and focused training to ensure guidelines are followed in busy children's EDs but the intervention demonstrated potential for rational antibiotic prescribing. References https://www.gov.uk/government/collections/group-a-streptococcal-infections-guidance-and-data accessed 16/8/23 Bird C, Winzor G, Lemon K, Moffat A, Newton T, Gray J. A pragmatic study to evaluate the use of a rapid diagnostic test to detect group A streptococcal pharyngitis in children with the aim of reducing antibiotic use in a UK emergency department. Pediatric Emergency Care, 2021;37(5):e249-e251.