[Streptococcal pharyngitis in the pediatric emergency department: value and impact of rapid antigen detection test]. / Angine streptococcique aux urgences pédiatriques: performances et impact d'un test de diagnostic rapide.

UNLABELLED: The French Health Agency (Afssaps) recommands the resort to the streptocoque rapid test strip for a better targetting of antibiotics prescription. OBJECTIVES: To evaluate the systematic use of the test in a pediatric emergengy department. METHODS: Comparison of results of the test to the laboratory cultures. Our study took place between January and December 2004. Two thousand one hundred (and) forty-four children with acute pharyngitis have been included (mean age: 4.8+/-3.6 years). RESULTS: Group A streptococcus was involved in 57 pharyngitis (26%). Mean age of children with positive culture was 7+/-3 years versus 4+/-3 years if culture was negative (p>0.05). The test sensitivity was 77% (CI 95%: 65-86) and its specificity 82% (CI 95%: 75-87), the positive predictive value was 60% (CI 95%: 49-71) and the negative predictive value 91% (CI 95%: 85-95). Antibiotic prescriptions have diminished: no prescription for 70% of pharyngitis and for 93% if cultures were negative. CONCLUSION: The rapid test strip wide use has a strong repercussion on the antibiotics prescription. This test is realist in pediatric emergency unit.

[Pediatric telephone advice in the emergency department]. / Les conseils téléphoniques aux urgences pédiatriques: expérience du centre hospitalier du Havre.

OBJECTIVES: To describe the activity of telephone advice in a pediatric emergency department and assess the influencing factors to improve quality of care. METHODS: Descriptive study about all the anonymous telephone calls received on the direct line of the pediatric emergency room of Le Havre hospital, from 25 January to 25 July 2002, and all the advices given by a doctor or a nurse. RESULTS: The mean daily call frequency was 2.15 (0-12) with 586 calls during the 6 months period and the mean call duration was 3 min (1-20). Parents took telephone advices for: fever (27%), digestive troubles (22%), and trauma (14%). We found no difference concerning symptoms according to season. The rush hours were, on a bimodal graph, 0-1 am and 8-9 pm, paralleling the rush activity of consultation in pediatric emergency room. The heavy days for phone advices during the week were Tuesday and Wednesday. We found no correlation between heavy days of week and phone call duration. Thirty percent of cases did not need any advice because the asks were only an orientation advice. Advice to go to our emergency department was done in 11% of orientation advice. The call duration was significantly longer for: (1) calls including several symptoms or griefs, (2) calls given by a nurse; (3) calls taking place during hours of lowest activity in the emergency room (between 6 and 12 am), (4) calls including advice about medication or diet; (5) calls for counselling an orientation other than medical establishment. CONCLUSION: Our assessment of telephone call advices represented the first step to improve the quality of answer to families. Next step will be written protocols to answer more adequately to main griefs and symptoms that lead families to search for phone counselling.