Maltezou 2008.

Study characteristics
Patient sampling	Cross‐sectional study Prospective design Sample: unclear Direct comparison of different RADTs: no Direct comparison of several throat culture techniques: no Person performing the throat sample: unclear Exclusion if recent antibiotics use before inclusion: yes (within the previous week) Clinical selection of patients: clinical score (Centor) Presenting signs and symptoms: clinical evidence of pharyngitis including one of the 4 Centor criteria (fever, tonsillar exudate, tender enlarged anterior cervical lymph nodes and absence of cough) Age range for inclusion: 2 to 14 years
Patient characteristics and setting	Sample size: 432 Age (distribution): mean = 6.8 years (calculated from data in table 1) GAS prevalence according to culture (with 95% confidence interval): 27.3% (95% CI not reported) Country of study: Greece Sex (% of girls): 53.9% Clinical severity assessment: Centor score Clinical setting: mixed (office‐based and hospital outpatient clinic) Multi‐centre study
Index tests	Throat swab: 2 different swabs (1 swab for culture, 1 swab for performing the RADT) Commercial name of the RADT: Link 2 Strep A Rapid Test (Becton Dickinson) Type of RADT: EIA
Target condition and reference standard(s)	Throat culture medium: standard Atmosphere of incubation: not reported Duration of incubation: 48 hours GAS confirmation: bacitracin disk and latex test Number of plates inoculated: not reported Assessment of GAS antibody response: no Relevant details: ‐
Flow and timing	No follow‐up
Comparative
Type of study	Journal article
Notes	Funded by the Hellenic Center for Disease Control and Prevention
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Was it a cross‐sectional study or a RCT?	Yes
Were selection criteria clearly described (at least presenting signs and symptoms and age limits for inclusion)?	Yes
Was clinical selection of patients avoided?	No
Were patients seen in an ambulatory care setting?	Yes
		Unclear	High
DOMAIN 2: Index Test All tests
Were the RADT results interpreted with blinding of the results of culture?	Yes
Was the type of the RADT mentioned (EIA or OIA)?	Yes
Were RADTs conducted during consultation time?	Yes
		Low	Low
DOMAIN 3: Reference Standard
Were culture results interpreted with blinding of the results of the RADT?	Unclear
Is the throat culture method likely to correctly identify GAS (laboratory culture on a blood agar plate during 48 hr)?	Yes
Were the culture medium, atmosphere, duration of incubation and GAS‐confirmation technique described?	No
		High	High
DOMAIN 4: Flow and Timing
Was the delay between the performance of the RADT and throat culture plating less than 48 hours?	Yes
Did all patients receive a throat culture?	Yes
Did patients receive the same throat culture method?	Yes
Were undetermined/uninterpretable results reported?	No
Were withdrawals from the study explained?	Yes
		Low