Added value of point-of-care testing for Group A Streptococcus in community pharmacy sore throat pathways: analysis of the Wales Sore Throat Test and Treat service

Objective
To evaluate the diagnostic performance of FeverPAIN against point-of-care test (POCT) results for Group A Streptococcus (GAS) among children and adults presenting with sore throat in community pharmacies.
Methods
Cross-sectional analysis of patients aged 6 years and over with sore throat presenting to community pharmacies across Wales delivering the Sore Throat Test and Treat service from November 2018 to September 2024. Patients scoring FeverPAIN ≥2 or Centor ≥3 who underwent POCT were eligible for analysis. We described GAS positivity by age group and assessed the diagnostic performance of FeverPAIN at the National Institute for Health and Care Excellence (NICE) antibiotic threshold (≥4), reporting sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve (AUROC) with 95% CIs. We estimated potential missed treatment and unnecessary antibiotic use if antibiotics were supplied based on FeverPAIN alone.
Results
Among 73 617 eligible patients, 37.0% (n = 27 220) tested positive for GAS by POCT. Positivity was highest among children aged 6 to 10 years (47.0%: 5339/11 371). FeverPAIN was used in 92.5% (n = 68 099) of assessments. At the NICE-recommended threshold for antibiotic treatment (FeverPAIN ≥4), sensitivity was 55.0% (95% CI: 54.4–55.6%) and specificity 77.0% (95% CI: 76.6–77.4%). Positive predictive value was 57.6% (95% CI: 57.0–58.2%) and negative predictive value 75.1% (95% CI: 74.7–75.5%). Overall AUROC was 0.70 (95% CI: 0.70–0.71), with the lowest AUROC of 0.69 (95% CI: 0.68–0.70) observed among children aged 6 to 10 years. Using FeverPAIN alone would miss 44% of patients testing positive for GAS and result in unnecessary antibiotics for 23% of patients testing negative.
Conclusions
FeverPAIN demonstrated limited diagnostic performance for identifying GAS when used alone, with greater discordance among children. Incorporating POCTs within community pharmacy sore throat pathways may support more targeted antibiotic prescribing. These findings support reconsideration of the role of POCT within community pharmacy sore throat pathways.