Department of Emergency Medicine, UZ Brussel, Vrije Universiteit Brussel, Jette, Belgium.
BMJ Open. 2013 Apr 22;3(4). doi: 10.1136/bmjopen-2013-002712. Print 2013.
Centor criteria (fever >38.5°C, swollen, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough) are an algorithm to assess the probability of group A β haemolytic Streptococcus (GABHS) as the origin of sore throat, developed for adults. We wanted to evaluate the correlation between Centor criteria and presence of GABHS in children with sore throat admitted to our paediatric emergency department (PED).
Retrospective cohort study.
The emergency department of a large tertiary university hospital in Brussels, with over 20 000 yearly visits for children below age 16.
All medical records (from 2008 to 2010) of children between ages 2 and 16, who were diagnosed with pharyngitis, tonsillitis or sore throat and having a throat swab culture for GABHS. Children with underlying chronic respiratory, cardiac, haematological or immunological diseases and children who had already received antibiotics (AB) prior to the PED consult were excluded. Only records with a full disease history were selected. Out of a total 2118 visits for sore throats, 441 met our criteria. The children were divided into two age groups, 2-5 and 5-16 years.
The prevalence of GABHS was higher in the older children compared to the preschoolers (38.7 vs 27.6; p=0.01), and the overall prevalence was 32%. There was no significant difference in the prevalence of GABHS for all different Centor scores within an age group. Likelihood ratios (LR) demonstrate that none of the individual symptoms or a Centor score of ≥3 seems to be effective in ruling in or ruling out GABHS. Pooled LR (CI) for Centor ≥3 was 0.67 (CI 0.50 to 0.90) for the preschoolers and 1.37 (CI 1.04 to 1.79) for the older children.
Our results confirm the ineffectiveness of Centor criteria as a predicting factor for finding GABHS in a throat swab culture in children.
Centor 标准（体温>38.5°C、肿胀、触痛的颈前淋巴结、扁桃体渗出物和无咳嗽）是一种用于评估 A 组β溶血性链球菌（GABHS）是否为咽痛病因的算法，该算法专为成年人开发。我们想评估 Centor 标准与我们儿科急诊部（PED）咽痛患儿 GABHS 阳性的相关性。
回顾性队列研究。
布鲁塞尔一家大型三级大学医院的急诊部，每年有 20000 多名 16 岁以下儿童就诊。
所有年龄在 2 至 16 岁之间、被诊断为咽炎、扁桃体炎或咽痛且进行 GABHS 咽拭子培养的患儿的病历（2008 年至 2010 年）。患有慢性呼吸道、心脏、血液或免疫疾病的患儿和在 PED 就诊前已接受抗生素（AB）治疗的患儿被排除在外。仅选择有完整病史记录的病历。在 2118 例咽痛就诊中，有 441 例符合我们的标准。患儿分为 2-5 岁和 5-16 岁两个年龄组。
与学龄前儿童相比，大龄儿童的 GABHS 阳性率更高（38.7%比 27.6%；p=0.01），总体阳性率为 32%。在同一年龄组内，各个 Centor 评分的 GABHS 阳性率无显著差异。似然比（LR）表明，单个症状或 Centor 评分≥3 均不能有效确定或排除 GABHS。对于学龄前儿童，Centor ≥3 的汇总 LR（CI）为 0.67（CI 0.50 至 0.90），对于大龄儿童，汇总 LR（CI）为 1.37（CI 1.04 至 1.79）。
我们的结果证实 Centor 标准作为预测因素在儿童咽拭子培养中发现 GABHS 并不有效。
