A clinical decision rule for streptococcal pharyngitis management: An update

Abstract PURPOSE: Group A streptococcal (GAS) pharyngitis is a common disease worldwide. We aimed to establish a pragmatic program as a clinical decision rule for GAS pharyngitis diagnosis. MATERIALS AND METHODS: This article derived from a research project on children aged 6–15 years. Five hundred...

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Bibliographic Details
Published in:Journal of laboratory physicians 2017-04, Vol.9 (2), p.116-120
Main Authors: Nasirian, Hosain, TarvijEslami, Saeedeh, Matini, Esfandiar, Bayesh, Seyedehsara, Omaraee, Yasaman
Format: Article
Language:English
Subjects:
Care and treatment
Diagnosis
erythema
Evaluation
exudate
lymph nodes
Original
Original Article
pharyngitis
Practice guidelines (Medicine)
Strep throat
streptococcal
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Summary:Abstract PURPOSE: Group A streptococcal (GAS) pharyngitis is a common disease worldwide. We aimed to establish a pragmatic program as a clinical decision rule for GAS pharyngitis diagnosis. MATERIALS AND METHODS: This article derived from a research project on children aged 6–15 years. Five hundred and seventy-one children met the enrollment criteria on whom throat culture and validities of clinical findings were assessed in positive and negative throat culture groups. RESULTS: Positive GAS throat culture group included 99 (17.3%) patients with a positive culture. Negative GAS throat culture group included 472 (82.6%) patients. Exudate or enlarged tender nodes each one had 63% and 68% sensitivity and 31.5% and 37.5% specificity with a high percentage of negative predictive value (NPV) 80.54% and 85.09%, respectively. Sequence test revealed validities of exudate plus enlarged nodes at 43.62% sensitivity and 57.19% specificity with 83% NPV. CONCLUSIONS: High NPV of 83% indicated that similar prevalence in the absence of either exudate or enlarged tender lymph nodes. Probability of GAS negative throat cultures among children suspected of GAS pharyngitis was 83% and would correctly not receive inopportune antibiotics.
ISSN:0974-2727
0974-7826
DOI:10.4103/0974-2727.199635