Latest news with #diagnosticaccuracy
Medscape
7 days ago
- Health
- Medscape
Point-of-Care Testing Cuts Antibiotic Use in Pharyngitis
TOPLINE: Point-of-care testing for group A beta-hemolytic Streptococcus (Strep A) significantly reduced antibiotic prescriptions in children and adults with signs of pharyngitis, even when used as the sole intervention. METHODOLOGY: Researchers performed a meta-analysis of eight randomized controlled trials conducted between 2007 and 2021, evaluating point-of-care testing for Strep A vs standard care. The analysis included 4249 children and adults with pharyngitis, cough, or sore throat who underwent point-of-care testing for Strep A either alone or alongside other interventions. Primary outcomes were the impacts on antibiotic prescriptions, clinical decisions, and patient health outcomes. Secondary endpoints assessed diagnostic accuracy of Strep A testing, including sensitivity and specificity measurements. TAKEAWAY: Point-of-care testing reduced antibiotic prescriptions by 38% compared with standard care (risk ratio [RR], 0.62; P < .0001) and by 41% when it was the sole intervention (RR, 0.59; P < .001). The implementation of point-of-care testing also led to a reduction in inappropriate antibiotic prescriptions (RR, 0.45; 95% CI, 0.31-0.97; P = .038). However, there were no significant differences in the patient health outcomes, such as days until pain resolution and days of school/work missed, the use of ancillary testing, or other medications such as analgesics with point-of-care testing. The reported diagnostic accuracy of Strep A point-of-care testing showed sensitivity ranging from 65% to 94% and specificity from 85% to 94%. IN PRACTICE: 'Physicians can therefore use Strep A POCTs [point-of-care tests] to inform their decisions on antibiotic prescribing without compromising patient health outcomes. In clinical practice, physicians must be aware of the limitations of Strep A POCTs, in particular, the limited sensitivity for detecting GAS [group A beta-hemolytic Streptococcus],' the authors of the study wrote. SOURCE: This study was led by Ann-Sophie Mägdefrau and Carolin Kathner-Schaffert, Jena University Hospital and InfectoGnostics Research Campus Jena, both in Jena, Germany. It was published online on July 9, 2025, in Open Forum Infectious Diseases. LIMITATIONS: High statistical heterogeneity in the meta-analyses limited the precision of the pooled effect estimates. Only three trials reported patient health outcomes, restricting evaluation of the effect of Strep A point-of-care tests on measures like recovery time. Additionally, none of the trials were blinded, introducing potential bias — particularly in evaluating subjective outcomes like pain and symptom resolution. DISCLOSURES: This study received funding from the German Federal Ministry of Education and Research. The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
23-05-2025
- Health
- Medscape
Ultrasound Achieves 95% Accuracy for Testicular Torsion
A systematic review and meta-analysis found that ultrasound had a high diagnostic accuracy for testicular torsion, with colour Doppler sonography achieved a sensitivity of 95.3% and a specificity of 98.3% in its detection. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 63 studies that included men presenting to secondary or tertiary care with suspected testicular torsion and who subsequently underwent diagnostic assessment with ultrasound. The analysis included colour Doppler sonography as the primary index test, with surgical scrotal exploration or clinical follow-up as reference standards. Of the studies included, 54 (85.7%) assessed colour Doppler sonography, and the others examined spectral Doppler sonography, contrast-enhanced ultrasound, or alternative ultrasound technologies. TAKEAWAY: Across 42 studies involving 4422 participants, colour Doppler sonography demonstrated high diagnostic accuracy, with a sensitivity of 95.3% (95% CI, 91.4-97.5) and a specificity of 98.3% (95% CI, 96.2-99.3) in detecting testicular torsion. The positive predictive value was 96.1% (95% CI, 91.4-98.4) and the negative predictive value was 97.9% (95% CI, 96.2-98.9), based on 1358 cases of testicular torsion. The analysis revealed that younger patient age, non-radiologist user status, and the implementation of point-of-care ultrasound did not have a significant effect on diagnostic accuracy. IN PRACTICE: "There is evidence to suggest that ultrasound is highly sensitive and specific for TT [testicular torsion] detection. The ideal patient pathway for suspected TT should integrate timely access to ultrasound alongside clinical assessment, with careful patient counselling," the authors wrote. SOURCE: This study was led by Cameron E. Alexander, Luton and Dunstable University Hospital, Luton, England. It was published online on May 13, 2025, in European Urology Focus . LIMITATIONS: Insufficient data reporting prevented the assessment of the effect of several predefined factors on diagnostic accuracy. Although the accuracy has improved over time with modern technology, previous studies demonstrated that junior radiologists were more likely to yield false negative results in a multicentre European study. DISCLOSURES: This study did not receive any specific funding. One author reported receiving infrastructure support from the National Institute for Health and Care Research Imperial Biomedical Research Centre and Imperial College Experimental Cancer Medicine Centre, research funding from the Urology Foundation, consultation fees from Janssen and Varian, and funding to attend scientific conferences from Janssen and Sonablate Corp.
