The Diagnosis of Strep Throat in Adults in the Emergency Room

Abstract

Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.

Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study

“…18,7,19 The clinical proforma collected information on age; sex; current smoking status; past history of quinsy; 20 data on symptom severity for the symptoms of sore throat, difficulty swallowing, fever, cough, coryza ('runny nose') headache, muscle ache, abdominal pain, diarrhoea vomiting, earache (each symptom was rated by the patient as 0 = no problem, 1 = slight problem, 2 = moderately bad problem, or 3 = severe problem). The doctor or nurse documented examination findings for oral temperature using TempaDOT ™ thermometers, 21 the severity of tonsillar and pharyngeal inflammation, the presence of cervical glands, tonsillar exudate, fetor and palatal oedema.…”

“…The doctor or nurse documented examination findings for oral temperature using TempaDOT ™ thermometers, 21 the severity of tonsillar and pharyngeal inflammation, the presence of cervical glands, tonsillar exudate, fetor and palatal oedema. 7,18,19 Throat swabs. At the training session in each practice clinicians were instructed in standard study procedures, including how to take a throat swab.…”

Papel do teste de detecção rápida do antígeno do estreptococcus pyogenes do grupo a em pacientes com faringoamigdalites

“…Falsenegative cultures are probably results of patients with small number of colonies, and many are holders. However, this exam may delay the recognition of streptococcus PT in 48 to 72 hours, preventing early diagnosis and antibiotic therapy would lose its value to abbreviate the symptoms of PT and reduce transmissions of GAS to other subjects 14 .…”

Evidence Based Practice in Using Antibiotics for Acute Tonsillitis in Primary Care Practice

“…Concerning the antibiotic prescribing practices for tonsillitis in adults and children, the guidelines recommend antibiotic treatment only in patients who were likely to have Group A streptococcus infection based on the presence of at least 3 of 4 Centor criteria, or patients with two or more Centor criteria in the presence of a positive rapid antigen detection test (RADT). [6] More recently, the Centor score was modified by incorporating the patient's age, which allows the physician to place patients in low-, moderate-, or high-risk groups. The use of the McIsaac Modified Centor score has helped in decreasing the inappropriate antibiotic use by almost 88%.…”