Universitäres Zentrum für Hausarztmedizin beider Basel, Basel, Switzerland.
Swiss Med Wkly. 2021 Jan 20;151:w20404. doi: 10.4414/smw.2021.20404. eCollection 2021 Jan 18.
The Centor criteria and the FeverPAIN score are recommended for guiding antibiotic prescription for tonsillitis, but they are not validated for this purpose. We aimed to identify risk factors for peritonsillar abscess in group A haemolytic streptococcus-negative tonsillitis and to test the performance of clinical scores and laboratory tests.
In a retrospective case-control study at two regional hospitals from January 2015 to June 2018, we identified all cases of peritonsillar abscess and used propensity score matching utilising age and gender to select two controls per case from all patients who had a rapid group A haemolytic streptococcus antigen test in the emergency department. Exclusion criteria were age <18 years, documented refusal and a positive antigen test. We abstracted patient history, physical examination and results of laboratory testing. Logistic regression analysis was used to identify risk factors.
We included 141 cases of peritonsillar abscess, matched with 282 controls. Higher Centor score, C-reactive protein and white blood cell count were significantly associated with peritonsillar abscess, but had a low performance for predicting the latter (area under the receiver operator characteristic curve [ROC AUC] 0.76). The FeverPAIN score was not associated with peritonsillar abscess (ROC AUC 0.51). In the multivariable analysis, difficulty swallowing (odds ratio [OR] 18.4, 95% confidence interval [CI] 6.58–51.2), dyspnoea (OR 10.2, 95% CI 1.18–89.0), tonsillar swelling (OR 4.21, 95% CI 1.39–12.7) and unilateral signs and symptoms (OR 146, 95% CI 40.9–522) were risk factors of peritonsillar abscess.
The Centor criteria, as well as C-reactive protein and white blood cell count, have a low discriminatory performance, and the FeverPAIN score is not useful in identifying patients at risk for peritonsillar abscess in group A haemolytic streptococcus-negative tonsillitis. To guide a rational antibiotic prescription, new decision tools need to be developed. These might include items such as difficulty swallowing, dyspnoea, tonsillar swelling and unilaterality.
针对扁桃体炎的抗生素处方，推荐使用 Centor 标准和 FeverPAIN 评分，但它们尚未针对该用途进行验证。我们旨在确定乙型溶血性链球菌阴性扁桃体炎并发扁桃体周脓肿的危险因素，并测试临床评分和实验室检查的性能。
在 2015 年 1 月至 2018 年 6 月期间，在两家区域医院进行了一项回顾性病例对照研究，我们确定了所有扁桃体周脓肿的病例，并利用年龄和性别利用倾向评分匹配选择了急诊科快速乙型溶血性链球菌抗原检测的所有患者中每例的两个对照。排除标准为年龄<18 岁，有记录的拒绝和抗原检测阳性。我们提取了患者病史、体格检查和实验室检查结果。使用逻辑回归分析确定危险因素。
我们纳入了 141 例扁桃体周脓肿病例，与 282 例对照相匹配。较高的 Centor 评分、C 反应蛋白和白细胞计数与扁桃体周脓肿显著相关，但对预测后者的性能较低（接受者操作特征曲线下面积 [ROC AUC] 0.76）。FeverPAIN 评分与扁桃体周脓肿无关（ROC AUC 0.51）。在多变量分析中，吞咽困难（比值比 [OR] 18.4，95%置信区间 [CI] 6.58-51.2）、呼吸困难（OR 10.2，95%CI 1.18-89.0）、扁桃体肿胀（OR 4.21，95%CI 1.39-12.7）和单侧症状和体征（OR 146，95%CI 40.9-522）是扁桃体周脓肿的危险因素。
Centor 标准以及 C 反应蛋白和白细胞计数的鉴别性能较低，FeverPAIN 评分对于识别乙型溶血性链球菌阴性扁桃体炎并发扁桃体周脓肿的风险患者没有用处。为了指导合理的抗生素处方，需要开发新的决策工具。这些工具可能包括吞咽困难、呼吸困难、扁桃体肿胀和单侧性等项目。
