Nationwide survey on the management of pediatric pharyngitis in Italian emergency units
Authors: Milani Gregorio P. , Rosa Claudio , Tuzger Naz , Alberti Ilaria , Ghizzi Chiara , Zampogna Stefania , Amigoni Angela , Agostoni Carlo , Peroni Diego , Marchisio Paola , Chiappini Elena ,   IPSE study group, Tappi Eleonora , Rabbone Ivana , Salvini Filippo M. , Cozzi Giorgio , Silvagni Davide , Pitea Marco , Manieri Sergio , Crisalfi Antonella , Vaccaro Angelina , Plebani Anna M. , Falorni Susanna , Martelli Laura , Lanari Marcello , Di Stefano Giuseppe , De Martinis Mauro , Bulciolu Pasquale , Iughetti Lorenzo , Fabiani Elisabetta , Greco Rita , Cardinale Fabio , Boera Riccardo , Arrighini Alberto , Chiaretti Antonio , Nunziata Felice , Salvo Rosario , Banderali Giuseppe , Fasoli Silvia , Baracchia Gabriella , Antonucci Roberto , Biondi Andrea , Tenci Andrea , Mirri Gianpaolo , Battisti Laura , Bellettato Massimo , Ruffini Ermanno , Cogo Paola , Dragovic Danica , Da Dalt Liviana , Bruni Paola , Caloiero Mimma , Varisco Tiziana , Palmieri Marcello , Picciotti Emanuela , Cualbu Antonio , Pradal Ugo , Grosso Salvatore , Pogliani Laura Maria , Selicorni Angelo , Soffiati Massimo , Bene Pietra , Guala Andrea , Bertolozzi Giuseppe , Tommasi Paola , Campanozzi Angelo , Cella Andrea , Ghitti Cesare , Groff Paolo , Bondone Claudia , Vitale Antonio , Capalbo Pina Teresa , Dall’Amico Roberto , Sisto Antonio , Livio Ecclesio L. , Tatò Emanuele , Flora Marina , Raiola Giuseppe , Suppiej Agnese , Clemente Ciro , Lizzoli Francesca , Chiarelli Francesco , Podestà Alberto , Forte Fabio R. , Vasarri Pierluigi , Pennoni Guido , Parrinello Flavia , Fornaro Martina , Casa Roberto della , Bondone Claudia , Zaglia Federico , Tipo Vincenzo , Morandi Francesco , Cecinati Valerio , Calabrò Giuseppe , Messini Beatrice , Marseglia Gian Luigi , Arrigoni Sergio , Gaggiano Santina , Cavalli Claudio , Gramaglia Giuseppe , Serra Laura , Valletta Enrico , Militerno Gaia , Chiossi Massimo , Camellino Gino , Masi Stefano , Marchetti Federico , Traina Giovanni , Maccarrone Rosa Maria 
Published: September 2023

Abstract
Background
Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units.

Methods
A multicentric national study was conducted in Italian emergency departments between April and June 2022.

Results
A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis.

Conclusions
The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis.