Comparison of clinical prediction rules for management of pharyngitis in settings with limited resources

Walker, Christa L. Fischer; Rimoin, Anne W.; Hamza, Hala; Steinhoff, Mark C.

doi:10.1016/j.jpeds.2006.03.005

Cited by 36 publications

(11 citation statements)

References 35 publications

(46 reference statements)

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“…Cervical adenopathy (variously defined as enlargement and/or tenderness) has improved the sensitivity of most decision rules (although not to the extent that we observed) and has been incorporated into numerous models. 20 Our findings suggest that if Bamako schoolchildren with sore throat were screened for cervical tenderness, then 2.3 GAS-negative children would be treated for every GAS-positive child treated, compared to a treatment ratio of 3.5:1 associated with the standard practice of treating all children with sore throat in our population.…”

Section: Discussionmentioning

confidence: 73%

Streptococcal Pharyngitis in Schoolchildren in Bamako, Mali

Tapia

Sow

Tamboura

et al. 2015

Pediatric Infectious Disease Journal

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Background Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease (RHD) in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren. Methods Surveillance for pharyngitis was conducted among children 5 to 16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods. Results GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy identified 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus non-vaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren. Conclusions Two promising strategies could reduce RHD in low resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.

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Section: Discussionmentioning

confidence: 73%

Streptococcal Pharyngitis in Schoolchildren in Bamako, Mali

Tapia

Sow

Tamboura

et al. 2015

Pediatric Infectious Disease Journal

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“…Sin embargo, sólo unos pocos han sido validados apropiadamente para ser usados con confianza en diferentes poblaciones y escenarios. Se sabe que esta falta de validación modifica la eficacia diagnóstica informada de las RPC 17…”

Section: Artículo Originalunclassified

Una regla de predicción clínica ¿anticipa el diagnóstico de la faringitis estreptocóccica en niños de 2 a 15 años?

Karzulovic

García

Wozniak

et al. 2018

Rev. chil. infectol.

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“…Existing clinical decision rules to diagnose GAS pharyngitis have not been validated in some regions of the world, such as sub-Saharan Africa, where RHD is endemic. An Egyptian study showed that the diagnostic performance varies considerably in different communities and regions of the world (10), thus highlighting the importance of evaluating and validating clinical decision rules in local settings before they are rolled out as the standard of care (11). …”

Section: Introductionmentioning

confidence: 99%