Scottish Paediatric Society Summer meeting Friday 9th June 2023 Suttie Centre for Teaching and Learning in Healthcare Foresthill Site, University of Aberdeen.

Background: Clinical decision scores are used to target antibiotic use for acute sore throat (AST) but are not well validated in children under 5 years old. NICE guidance recommends antibiotics in AST where FeverPAIN score is >4. Following an increase in Group A streptococcal (GAS) transmission in December 2022, Public Health Scotland (PHS) interim guidance lowered this prescribing threshold to a FeverPAIN score >3. Objectives: To audit antibiotic prescribing for upper respiratory tract infection (URTI)/AST in the PED in the context of the GAS public health alert in December 2022 with NICE and interim PHS guidance as reference standards. To determine the diagnostic accuracy of the FeverPAIN score in predicting con fi rmed GAS infection. Population: All children aged 3 to 16 years who presented to the PED between 3 and 16 December 2022, who had a throat swab for bacterial culture. Methods: Cases were identi fi ed from laboratory sample data. FeverPAIN scores retrospectively assigned from clinical records. Descriptive statistics were calculated in excel. Received operator characteristic (ROC)curves were created using XLSTAT. Only children with a diagnosis of URTI/AST and calculable FeverPAIN score were included.