Institute of Applied Health Research, University of Birmingham, Birmingham.
Br J Gen Pract. 2020 Mar 26;70(693):e245-e254. doi: 10.3399/bjgp20X708833. Print 2020 Apr.
Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis.
To compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with pharyngitis.
A meta-analysis of diagnostic test accuracy studies conducted in primary care was performed using a novel model that incorporates data at multiple thresholds.
MEDLINE, EMBASE, and PsycINFO were searched for studies published between January 1980 and February 2019. Included studies were: cross-sectional; recruited patients with sore throats from primary care; used the Centor or McIsaac score; had GABHS infection as the target diagnosis; used throat swab culture as the reference standard; and reported 2 × 2 tables across multiple thresholds. Selection and data extraction were conducted by two independent reviewers. QUADAS-2 was used to assess study quality. Summary receiver operating characteristic (SROC) curves were synthesised. Calibration curves were used to assess the transferability of results into practice.
Ten studies using the Centor score and eight using the McIsaac score were included. The prevalence of GABHS ranged between 4% and 44%. The areas under the SROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The -value for the difference (0.0164) was 0.419, suggesting the SROC curves for the tests are equivalent. Both scores demonstrated poor calibration.
Both Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection.
Centor 和 McIsaac 评分都用于诊断 A 组乙型溶血性链球菌（GABHS）感染，但尚未通过荟萃分析进行比较。
比较 Centor 和 McIsaac 评分在诊断初诊为咽炎的 GABHS 患者方面的表现。
对初级保健中进行的诊断测试准确性研究进行了荟萃分析，使用了一种新的模型，该模型整合了多个阈值的数据。
使用 MEDLINE、EMBASE 和 PsycINFO 检索了 1980 年 1 月至 2019 年 2 月期间发表的研究。纳入的研究为：横断面研究；从初级保健中招募咽痛患者；使用 Centor 或 McIsaac 评分；以 GABHS 感染为目标诊断；使用咽拭子培养作为参考标准；并报告了多个阈值的 2×2 表。由两名独立的审查员进行选择和数据提取。使用 QUADAS-2 评估研究质量。综合汇总接收者操作特征（SROC）曲线。校准曲线用于评估结果在实践中的可转移性。
纳入了 10 项使用 Centor 评分和 8 项使用 McIsaac 评分的研究。GABHS 的患病率在 4%至 44%之间。McIsaac 和 Centor 评分的 SROC 曲线下面积分别为 0.7052 和 0.6888。差异的 - 值（0.0164）为 0.419，表明两种测试的 SROC 曲线等效。两种评分的校准都较差。
Centor 和 McIsaac 评分都仅能对 GABHS 患者和非 GABHS 患者进行适度区分，并且在性能上似乎大致相当。阳性测试结果的校准不良表明需要其他即时护理测试来确诊 GABHS；然而，对于 Centor 和 McIsaac 评分，评分≤0 可能足以排除感染。
