Is it required to perform culture follow-up on all negative rapid Group A Strep screens?

Any examples are for illustrative purposes only.

The manufacturer's package insert recommends that all negative rapid Group A Strep screens be followed-up with a culture. The Joint Commission surveys compliance with following these manufacturer instructions. Thus, culture follow-up should be performed unless the laboratory has performed a study that justifies discontinuing such testing.

An acceptable study consists of age-specific (adults vs. children) parallel testing that demonstrates acceptable correlation of results from rapid testing against cultures for the laboratory's setting. The study may be simple (20 - 100 samples) and rely upon existing data. Correlations tend to be better for the adult population as compared to children as specimens are easier to collect and they have a higher colonization rate. Specimens from children have a higher potential for a false negative rapid test (low colonization, difficult collection) and a higher risk of further disease (such as rheumatic or scarlet fever), thus culture follow-up is recommended for this population.  
This approach is consistent with the American Pediatric Association Guidelines (Pediatric Redbook 2002), the IDSA Guidelines for Diagnosis and Management of GAS and current recommendations for acute pharyngitis from the Centers for Disease Control.

A laboratory will be considered compliant if an age based study was performed and the laboratory director and physicians have considered these guidelines in developing the approved laboratory policy.