A clinical decision rule for streptococcal pharyngitis management: An update.

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.