1. Ihlenfeld, Janet T. PhD, RN

Article Content

Diaz MCG, Symons N, Ramundo ML, Christopher NC. Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department. Arch Pediatr Adolesc Med. 2004;158:977-981.


Identifying cases of pharyngitis due to group A [beta]-hemolytic streptococci (GABHS) is difficult since these cases can be confused with viral causes of sore throats. Many times, children are treated with antibiotics when their sore throat is due to a virus. The environment in busy emergency departments (EDs) makes it more likely for the misdiagnosis to occur.


This study investigated whether a new clinical pathway and further education regarding the identification and treatment of sore throat reduced the numbers of inappropriately identified cases of pharyngitis using a preanalysis and postanalysis. The pathway consisted of identifying children via testing for GABHS. If rapid testing was positive, children were medicated with appropriate antibiotics, usually penicillin-the treatment of choice. If the rapid test was negative, the throat culture was done and the child was only treated if that came back positive. Since it takes time to do a culture, treatment was delayed by several days in these cases.


Data were gathered from 219 children seen in the ED during August 2001 through November 2002. These children were tested using a rapid streptococcal antigen test (RST).


These data were compared with data from 224 children who came to the same ED during August 2003 through November 2003 for sore throat. These children came for treatment after the initiation of the pathway and educational program. When the data from the 2 groups were compared, it was found that only 44% of the children in 2002 received the appropriate treatment for sore throat but that 91% of the children in 2003 received the appropriate treatment. This was a substantial increase in appropriate care that could be directly attributed to the institution of the clinical pathway.


The data clearly showed that a clinical pathway, if followed very carefully, reduced the numbers of children who were treated inappropriately for sore throat. Since the false negative total was about 4% regarding the RST, it can also be inferred that rapid testing can help identify the bacterial cases of pharyngitis and help children be treated earlier and more cost-effectively in EDs.


Call for Manuscripts

If you are a critical care nurse, nurse-educator, nurse-manager, nurse practitioner, or clinical nurse specialist, researcher, or someone interested in critical care nursing, Dimensions of Critical Care Nursing would like to hear from you.


We are looking for manuscripts in critical care topics with direct application to clinical practice, leadership, education, or research. Specifically, we are interested in manuscripts on the latest critical care technology, drugs, research, procedures, leadership strategies, ethical issues, career development, and patient/family education.


Your work must not have been previously published elsewhere or be under consideration for publication in other journals or books.


Manuscripts should be typed, double-spaced, and followed by references, tables, figures, and black-and-white artwork (when appropriate). Number references consecutively in the body of your manuscript and place reference citations at the end of the article. Do not reference commonly held opinions and perceptions unless their history is the article's principal topic. Follow the standard practice for legal citations. Also be sure to include an abstract for your article and biographic information for all authors. All manuscripts must be accompanied with a diskette or can be e-mailed directly to Manuscripts not accompanied by a diskette or sent electronically will be returned.


Send your query letter or manuscript including three hard copies and disk (or electronically) to:


Dimensions of Critical Care Nursing


Vickie Miracle, EdD, RN, CCRN, CCNS, CCRC




424 Eastgate Village Wynde


Louisville, KY 40223


For more detailed author guidelines, visit our Web site: