Clinical Scoring System in the Evaluation of Adult Pharyngitis

Seppälä, Helena; Lahtonen, Riitta; Ziegler, Thedi; Meurman, Olli; Hakkarainen, Kati; Miettinen, A; Arstila, Pertti; Eskola, J.; Saikku, Pekka; Huovinen, Pentti

doi:10.1001/archotol.1993.01880150036006

Cited by 18 publications

(15 citation statements)

References 16 publications

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“…Group A Streptococcus (GAS) is the most common and important cause of sore throat that may benefit from antibiotic treatment. 32 The probability of detecting GAS in patients presenting with an acute sore throat is 5-40%, [33][34][35][36][37][38][39][40][41] depending on clinical setting (higher in EDs and lower in primary care), season (higher in autumn and winter), age (higher in children, lower in adults), and clinical symptoms and signs. Diagnostic error is associated with unnecessary antibiotic prescribing.…”

Section: Clinical Prediction Rulesmentioning

confidence: 99%

Reducing uncertainty in managing respiratory tract infections in primary care

2010

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Respiratory tract infections (RTIs) remain the commonest reason for acute consultations in primary care in resource-rich countries. Their spectrum and severity has changed from the time that antibiotics were discovered, largely from improvements in the socioeconomic determinants of health as well as vaccination. The benefits from antibiotic treatment for common RTIs have been shown to be largely overstated. Nevertheless, serious infections do occur. Currently, no clinical features or diagnostic test, alone or in combination, adequately determine diagnosis, aetiology, prognosis, or response to treatment. This narrative review focuses on emerging evidence aimed at helping clinicians reduce and manage uncertainty in treating RTIs. Consultation rate and prescribing rate trends are described, evidence of increasing rates of complications are discussed, and studies and the association with antibiotic prescribing are examined. Methods of improving diagnosis and identifying those patients who are at increased risk of complications from RTIs, using clinical scoring systems, biomarkers, and point of care tests are also discussed. The evidence for alternative management options for RTIs are summarised and the methods for changing public and clinicians' beliefs about antibiotics, including ways in which we can improve clinician-patient communication skills for management of RTIs, are described.

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Section: Clinical Prediction Rulesmentioning

confidence: 99%

Reducing uncertainty in managing respiratory tract infections in primary care

2010

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“…These include tonsillar enlargement and exudate, tender and enlarged cervical nodes, and fever. [18][19][20] Whether clinicians base their impressions of the probability of GABHSP on the most predictive signs and symptoms, and the concordance between clinical impression and the probability of GABHSP, is unknown. We studied the association between clinical impression of GABHSP and predictive signs and symptoms, as well as the predictive accuracy of clinical impression compared with the results of throat culture, in the urgent care center of a major university health service.…”

mentioning

confidence: 99%

“…Clinical predictors of GABHSP extracted from the literature (fever, throat soreness, cough, adenopathy, tonsillar enlargement, tonsillar exudate, and pharyngeal erythema) were included. [18][19][20] Each predictor variable was scored on an ordinal scale. Pharyngeal erythema was categorized as none, mild, moderate, or severe (bright red).…”

mentioning

confidence: 99%

Concordance of Clinical Findings and Clinical Judgment in the Diagnosis of Streptococcal Pharyngitis

Nawaz

Smith

Mazhari

et al. 2000

Academic Emergency Medicine

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Abstract. Objective: It is uncertain how reliably clinicians apply clinical predictors of group A beta hemolytic streptococcal pharyngitis (GABHSP) to form a clinical impression, and how reliably this impression predicts culture results. The objective was to study clinician accuracy in diagnosing GABHSP. Methods: This was a prospective cohort study, conducted at an urgent care center of a major university. A convenience sample of 218 patients, aged 9-83 years, presenting with sore throat, was enrolled. Symptoms and signs of pharyngitis were documented on a standardized form; the likelihood of GABHSP was plotted on a visual analog scale; and throat culture was obtained. A comparison was then made between the clinical impression on presentation and the throat culture result. Results: Throat cultures were positive for GABHSP in 41 patients (19%). The probability of GABHSP was related to node size and tenderness, tonsillar exudate and hypertrophy, and pharyngeal erythema (p < 0.05); but not throat soreness, degree of fever, or cough. A strong clinical impression of GABHSP (>50% on the visual analog scale) was associated with tonsillar exudate and hypertrophy, tender nodes, and pharyngeal erythema. Together, these four predictors had a sensitivity of 71%, a specificity of 77%, and a positive predictive value of 46%. Conclusions: Clinicians in this study based their impression of GABHSP on the most reliable symptoms and signs. While a strong clinical suspicion of GABHSP predicted a greater probability of positive culture, the clinicians consistently overestimated the probability of GABHSP. Symptoms and signs predict GABHSP unreliably when used alone; they are helpful in modifying estimates of disease probability to facilitate optimal use of laboratory tests and antibiotics. Key words: streptococcal infections, diagnosis; pharyngitis, microbiology; reagent kits; diagnostic, standards. ACADEMIC EMERGENCY MEDICINE 2000; 7:1104-1109 S ORE throat is the sixth leading cause of visits to physicians in the ambulatory care setting, resulting in nearly 21 million visits each year. 1 Group A beta hemolytic streptococcal pharyngitis (GABHSP) accounts for only 10-20% of sore throats, 2-4 most cases being of viral etiology. Treatment of GABHSP with antibiotics is indicated to prevent post-streptococcal rheumatic fever in susceptible patients. 5,6 Clinicians are known to overestimate the probability of GABHSP based on clinical findings alone, 7 and consequently antibiotics are prescribed for up to 75% of patients. [8][9][10][11][12][13][14][15] Inappropriate use of antibiotics contributes to microbial resistance, and is considered an important public health threat in the United States. Clinical impression of GABHSP has been reported to have a sensitivity of 0.39, a specificity of 0.55, and an accuracy of 0.51. 17 Certain clinical signs and symptoms are associated with a higher likelihood of GABHSP. These include tonsillar enlargement and exudate, tender and enlarged cervical nodes, and fever. [18][19][20] Whether clinicians base the...

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“…14,15,23,24 However, we included the study of Centor et al 25 because it is widely quoted in the literature, is incorporated in a published standard of practice for adults, and has been evaluated retrospectively in a few studies in children. 26,27 We also identified prediction rules with prospective validation studies for the clinical diagnosis of GAS in pediatric populations. [26][27][28][29][30][31][32] All original diagnostic rules were assessed using recent criteria suggested for clinical prediction rules (Table I).…”

Section: Literature Reviewmentioning

confidence: 99%

“…26,27 We also identified prediction rules with prospective validation studies for the clinical diagnosis of GAS in pediatric populations. [26][27][28][29][30][31][32] All original diagnostic rules were assessed using recent criteria suggested for clinical prediction rules (Table I). 33 Those rules meeting most of the recommended methodological criteria, plus the current WHO prediction rule, were included in this assessment (Table II).…”

Section: Literature Reviewmentioning

confidence: 99%