Is not ordering a 2nd level strep test normal?

We do only rapid streps in our ER.

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.

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.

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!

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)

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.

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.

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.

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.

Well, this kid ran a hot fever all night. I had to keep waking him up to give him something to drink and alternate between the Tylanol and Motrin....more white patches this morning...I've already decided if that fever doesn't break by this afternoon, I'm taking him back.

I finally just put him in bed with me because I couldn't stand him being in the other room.

Hijack: Does anyone know of a brand of ear thermometer that actually works? I have 3 at the house that all have 1 sec reads and not one of them showed a fever...I have a stash of the old rectal thermometers and oral, and if I didn't have that, I wouldn't have known how high the fever was (which at the highest was 102.8) . I hate those electric things!