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Clinical Scoring Systems Can Help in the Diagnosis of Strep Pharyngitis

Question

  • In children with a complaint of sore throat, how does a clinical scoring system compare to a rapid screen in diagnosis of strep pharyngitis?

Clinical Bottom Lines

  1. A clinical scoring system for strep pharyngitis, using elements of history and physical, can help cross a treatment threshold, and minimize the number of chilren who need throat swabs.


Summary of Key Evidence

  1. Treating strep pharyngitis with appropriate antibiotics decreases risk of acute rheumatic fever, but not that of post-streptococcal glomerulonephritis.
  2. The clinical scoring system used in the University of Michigan Pharyngitis Guideline (as described by Wald, et al) can help cross a treatment threshold without needing to use throat swabs.
    For each finding, score +1: Absence of cough, rhinorrhea, and conjunctivitis; Fever, Erythema, swelling, or exudate of tonsils/pharynx; Age 5-15, tender anterior cervical nodes; season is Nov-May.
    Score of 0: +LR: 0.28 -LR: 1.1; if pre-test probability is 40%, post-test is 15-20%
    Score of 5-6: +LR: 3.14 -LR: 0.8; if pre-test probability is 40%, post-test is 70-75%
  3. The clinical scoring system by MsIsaac, et al used fewer clinical findings (5 vs 6) and had positive likelihood ratios farther away from 1.
    Findings: Absence of cough, rhinorrhea, fever, swelling/exudate of tonsils/pharynx, age<15yrs, tender cervical nodes.
    Score of 0: +LR: 0.02 -LR: 1.6; if pre-test probability is 40%, post-test is 1-2%
    Score of 4-5: +LR: 6.37 -LR: 0.5; if pre-test probability is 40%, post-test is 80%
  4. The University of Michigan Pharyngitis Guidelines uses presence of cough, rhinorrhea or conjuctivitis to exclude strep pharungitis (level of evidence not stated).

Additional Comments

Citation

  1. University of Michigan Medical Center Pharyngitis Guideline, December 2000
  2. Wald et al, A streptococcal score card revisited.Ped Emerg Care 1998;14 (2):109-11.
  3. McIssac et al, The validity of a sore throat score in family practice. CMAJ 2000; 163(7):811-5.

CAT Author: Sarah Gelehrter, MD

CAT Appraisers: Robert Schumacher, MD

Date appraised: March 18, 2002

Last updated October 27, 2002
Department of Pediatrics and Communicable Diseases
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