Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
Medical School, University of Bristol, Bristol, Avon, UK.
Emerg Med J. 2021 Aug;38(8):613-616. doi: 10.1136/emermed-2020-210786. Epub 2021 Apr 15.
Tonsillopharyngitis is a common presentation to paediatric emergency departments (PEDs). FeverPAIN (FP) and Centor scoring systems are recommended in the UK to help delineate bacterial aetiology, despite being primarily evidenced in adult populations. We investigate how the use of FP or Centor compares to actual clinician practice in guiding antibiotic prescription rates in PED. We establish current national practice in English PEDs.
We performed a retrospective cohort study of tonsillopharyngitis presentations to a tertiary PED in January-February 2020. Investigators retrospectively assigned each patient FP and Centor scores using documented symptoms. We compared antibiotic prescription rates guided by FP/Centor against the actual rate prescribed by clinicians, and assessed agreement between these strategies using kappa analysis. We contacted 153 English emergency departments to establish national practice.
We identified 632 consecutive patients aged 6 months to 15 years. Actual clinician-prescribed antibiotics numbered 116 (18.4%). Prescriptions predicted by FP score numbered 124 (19.6%) and Centor 112 (17.7%). Kappa (K) analysis indicated only moderate agreement between clinician choice versus FP (K=0.434) and clinician choice versus Centor (K=0.476). This was similar for cohorts aged under and over 3 years.National practice was reportedly heterogeneous, with 70 emergency departments (45.8%) not employing a specific system.
Current guidance is variably interpreted and inconsistently implemented in paediatric populations. FeverPAIN and Centor scoring systems may not rationalise antibiotics as much as previously reported compared with judicious clinician practice. Producing clear paediatric-specific national guidelines, especially for under-5s who are omitted from NICE sore throat guidance, may help further rationalise and standardise antibiotic use in paediatric tonsillopharyngitis.
扁桃体咽炎是儿科急诊部（PED）常见的就诊原因。在英国，FeverPAIN（FP）和 Centor 评分系统被推荐用于帮助确定细菌病因，尽管这些系统主要在成年人群中得到证实。我们研究了 FP 或 Centor 的使用如何与实际临床医生的实践相比较，以指导 PED 中抗生素的处方率。我们确定了英国儿科急诊的当前国家实践。
我们对 2020 年 1 月至 2 月期间一家三级 PED 的扁桃体咽炎就诊患者进行了回顾性队列研究。调查人员使用记录的症状回顾性地为每位患者分配 FP 和 Centor 评分。我们比较了 FP/Centor 指导的抗生素处方率与临床医生实际开具的处方率，并使用 Kappa 分析评估这些策略之间的一致性。我们联系了 153 家英国急诊部以确定国家实践。
我们确定了 632 名年龄在 6 个月至 15 岁的连续患者。实际临床医生开具的抗生素数量为 116 例（18.4%）。FP 评分预测的处方数量为 124 例（19.6%），Centor 为 112 例（17.7%）。Kappa（K）分析表明，临床医生选择与 FP（K=0.434）和临床医生选择与 Centor（K=0.476）之间只有中度一致性。3 岁以下和 3 岁以上患者的情况类似。据报道，国家实践存在异质性，70 家急诊部（45.8%）未采用特定系统。
目前的指南在儿科人群中存在不同程度的解释和不一致的实施。与明智的临床医生实践相比，FeverPAIN 和 Centor 评分系统可能不会像之前报道的那样减少抗生素的使用。制定明确的儿科专用国家指南，特别是针对 NICE 咽痛指南中未涵盖的 5 岁以下儿童，可能有助于进一步合理化和标准化儿科扁桃体咽炎中的抗生素使用。
