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Strep throat app could reduce unnecessary doctor visits

Coughing is often a sign of the flu or cold, not strep. (Globe staff photo / Bill Greene)
Coughing is often a sign of the flu or cold, not strep. (Globe staff photo / Bill Greene)

While most of us skip visits to the doctor when we know it’s just a cold, what about when it’s accompanied by a nagging sore throat? Should we head to the doctor’s office for a strep test? Many of us do, but fewer than one in four patients who get strep tests when they have sore throats test positive.

Boston Children’s Hospital researchers believe they have found a way to potentially reduce unnecessary medical appointments by using a new risk assessment tool that combines a patients’ symptoms with data tracking the incidence of strep infections in a local area. In a study published in the Annals of Internal Medicine, the researchers examined medical records from more than 70,000 patients over age 15 who visited outpatient MinuteClinics for strep tests and found that having a sore throat along with a fever but no cough put a person at higher risk of having strep.

These patients were justified in seeing a doctor to have a physical exam and strep test, said study co-author Dr. Andrew Fine, a pediatric emergency medicine physician at Boston Children’s. The study also found that those with “low-risk” symptoms who lived in places where strep wasn’t widely circulating had a very low chance of having a positive strep infection and would have been fine skipping a trip to the doctor.

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One caveat: Children under 15 were excluded from the study because the American Academy of Pediatrics recommends they get sore throats checked out regardless of other symptoms; that’s because the bacterial infection is more common in young kids and tends to be more serious.

Developing an app doctors can use to track strep trends should be fairly easy, said study co-author Dr. Kenneth Mandl, director of Boston Children’s intelligent health laboratory, and could be similar to one developed recently by researchers at the hospital to track the flu.

Unlike the flu app, the strep app could be used all year. “Unlike the flu, strep doesn’t have a set season and can circulate at any time of the year,” said Mandl. Business travelers who develop sore throats may have a trickier time using just local trends to predict their infections, he added, so doctors might need to check trends in other cities where they traveled.

If the new technology is developed and widely adopted, some 230,000 doctor visits could be avoided each year, the researchers calculated; this would also cause 8,500 strep cases to be missed, but most adults with strep have infections that resolve on their own in a few days.

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