Is not ordering a 2nd level strep test normal?

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Not asking medical advice...this is strictly a protocol question.

My son just woke up from a nap this after noon, 103 deg fever, looked at his throat...tons of white patches. This kid has had strep 4 times...his "spirts" are always good and other than the fact he is one hot tamale, you wouldn't even know the kid was sick. I gave him Motrin immediately.

So it's Sunday, two hours later I take him to Urgent care, and their was a Nurse Practitioner there, which I am ok with.

They did a rapid strep screen on this kid (he has NEVER had patches on his throat that ended up not being strep), it came back negative and told me just to take the kid home...so I said, "So will the results be back on the strep test you send off be back by Tuesday or Wednesay?"

She said, "Oh, we don't send those out, we do rapid-strep only here."

I said, "And those are always accurate?"

Her answer: "Yup...we don't see a reason to send it out".

I have NEVER taken either one of these kids to the doc for strep that they didn't send it off.

Am I nuts, or is she?

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Specializes in Emergency & Trauma/Adult ICU.

We do only rapid streps in our ER.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

I used to work for a pediatrician and we always did a 24 hour test if the rapid test came back negative.

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Specializes in Maternal - Child Health.

Because of my daughter's history of frequent (and sometimes mid-diagnosed) strep infections, I simply ask for both a rapid strep and a culture and sensitivity. It is more expensive, and in most cases, probably not strictly necessary, but it gives me peace of mind that she is on the right antibiotic.

I also know of a neighbor girl who became deathly ill despite a negative rapid strep. Turns out she had a staph infection of her throat that would have been diagnosed and properly treated much sooner if a C+S had been done.

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There is a difference between a rapid strep and a C&S. Rapid strep does not test for staph.

We only did rapid streps in the ER.

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At many facilities it is only protocol to do the Rapid Strep. At Urgent Care, they are providing only urgent care. Best suggestion is to take your child to their pediatrician on Monday if you want it to be done.

Unless you specifically asked to have a C and S done, it is usually not going to be done. And if you were in the room when they did the rapid strep, you would have only seen one swap used. For the C and S, they will usually use two.

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Ahhh...ok...that answers my question! Thanks everyone.

I'll just monitor her, like they said, and see if his fever goes away...I had just never seen that (even with myself) and it just seemed weird.

Thanks!

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Specializes in Infection Preventionist/ Occ Health.

The policy in the laboratory I work at is to send all negative rapid strep tests out for culture. This is in line with data from the literature for high risk patients:

Here is an article from the Journal of Family Practice:

http://findarticles.com/p/articles/mi_m0689/is_10_52/ai_109218194

However, another study states that the negative predictive value is 99% and that culture is not indicated in light of a negative test:

http://www.psmid.org.ph/vol29/vol29num3topic1.pdf

The accuracy of these antigen tests has improved over time to the point where they are now quite reliable. It is financially and scientifically prudent to change laboratory policies in light of this new evidence, depending on recommendations of the manufacturer and the preference of the pathologist.

Hope this helps.

BSNDec06

MT(ASCP)

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Specializes in Maternal - Child Health.
There is a difference between a rapid strep and a C&S. Rapid strep does not test for staph.

I understand that, Tazzi, but I don't think that the general public does. A negative rapid strep may rule out a strep infection, but does not rule out any other bacterial infection. Unfortunately for that girl, the staph was not diagnosed until she was deathly ill several days later. Had a culture been done in her pediatrician's office when the rapid strep was negative, she would have been diagnosed much sooner and spared the life-threatening illness she suffered.

I understand that in the interest of saving time and money, many physicians do not send cultures if a rapid strep is done. For my family, I request them, because I think they are important safeguards, and I am willing to pay extra for them.

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I understand that, Tazzi, but I don't think that the general public does. A negative rapid strep may rule out a strep infection, but does not rule out any other bacterial infection. Unfortunately for that girl, the staph was not diagnosed until she was deathly ill several days later. Had a culture been done in her pediatrician's office when the rapid strep was negative, she would have been diagnosed much sooner and spared the life-threatening illness she suffered.

I understand that in the interest of saving time and money, many physicians do not send cultures if a rapid strep is done. For my family, I request them, because I think they are important safeguards, and I am willing to pay extra for them.

That is a wonderful insight on that (and I'm sure I'll learn more about all of it when I start my RN program this month).

I do realize how serious those types of infections are...there is nothing routine about them.

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Specializes in Cardiac/ED.

Many years ago I used to work in a hospital lab as a lab assistant. Our lab police was that we would perform the rapid strep and then we would plate it in case it was something else.

I once had a bad sore throat, but the rapid test was negative. The plate actually grew Beta strep (I did not know at the time but a common cause of throat infection) which of course the rapid did not test for. My co-workers had been teasing me about trying to get out of work but I knew something was wrong.

If they are not plating the swab then they are sure leaving themselves open to potential litigation and its such an easy thing to do.

P2

Its been my experience that most physicians will treat the symptoms (fever, white patches, pain) no matter what the rapid test shows just in case it is something else.

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Specializes in NICU.

I just got back from a camp nursing job. Several of the staff said the rapid strep test only tests for type A and B, which are the most common. One of the girls actually had hers cultured out to be strep G and another girl's cultured out to strep C. If your daughter doesn't start to show signs of improvement, I'd request a culture.

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