抗生素处方和皮质类固醇在急诊科治疗急性单纯性咽炎中的应用。
Antibiotic prescribing and use of corticosteroids for the emergency department management of acute uncomplicated pharyngitis.
机构信息
Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Ontario, Canada.
Department Medicine, Division of Emergency Medicine, University of Toronto, Ontario, Canada.
出版信息
Fam Pract. 2021 Nov 24;38(6):731-734. doi: 10.1093/fampra/cmab035.
BACKGROUND
Acute pharyngitis is common in the ambulatory setting. The Modified Centor score uses five criteria to predict Group A Streptococcus (GAS) infection and can be used to guide management.
OBJECTIVE
The objective of this study was to describe the emergency department (ED) management (throat cultures, antibiotics and corticosteroids) of acute, uncomplicated pharyngitis by Centor score.
METHODS
This was a retrospective chart review of adult (>17 years) patients with an ED discharge diagnosis of acute pharyngitis from January 2016 to December 2018.
RESULTS
Of 638 patients included, 286 (44.8%) had a Centor score of 0-1, 328 (51.4%) had a score of 2-3 and 24 (3.8%) had a score of ≥4. Of those with a Centor score of 0-1, 83 (29.0%) had a throat culture, 88 (30.8%) were prescribed antibiotics, 15 (5.2%) were positive for GAS and 74 (25.9%) received corticosteroids. Of those with a Centor score of 2-3, 156 (47.6%) had a throat culture, 220 (67.1%) were prescribed antibiotics, 44 (13.4%) were positive for GAS and 145 (44.2%) received corticosteroids. Of those with a Centor score ≥4, 14 (58.3%) had a throat culture, 18 (75.0%) were prescribed antibiotics, 7 (29.2%) were positive for GAS and 12 (50.0%) received corticosteroids.
CONCLUSIONS
A higher Centor score was associated with a higher risk of GAS infection, increased antibiotic prescribing and use of corticosteroids. Many patients with low Centor scores were prescribed antibiotics and had throat cultures. Further work is required to understand clinical decision-making for the management of acute pharyngitis.
背景
急性咽炎在门诊中很常见。改良的 Centor 评分使用五个标准来预测 A 组链球菌（GAS）感染，并可用于指导管理。
目的
本研究旨在描述 Centor 评分在急性、不复杂咽炎的急诊科（ED）管理（咽喉培养、抗生素和皮质类固醇）。
方法
这是一项回顾性图表审查，纳入了 2016 年 1 月至 2018 年 12 月期间因 ED 急性咽炎出院诊断的成年（>17 岁）患者。
结果
在 638 例患者中，286 例（44.8%）的 Centor 评分为 0-1，328 例（51.4%）的评分为 2-3，24 例（3.8%）的评分为≥4。Centor 评分为 0-1 的患者中，83 例（29.0%）进行了咽喉培养，88 例（30.8%）接受了抗生素治疗，15 例（5.2%）GAS 阳性，74 例（25.9%）接受了皮质类固醇治疗。Centor 评分为 2-3 的患者中，156 例（47.6%）进行了咽喉培养，220 例（67.1%）接受了抗生素治疗，44 例（13.4%）GAS 阳性，145 例（44.2%）接受了皮质类固醇治疗。Centor 评分为≥4 的患者中，14 例（58.3%）进行了咽喉培养，18 例（75.0%）接受了抗生素治疗，7 例（29.2%）GAS 阳性，12 例（50.0%）接受了皮质类固醇治疗。
结论
Centor 评分越高，GAS 感染风险越高，抗生素使用率和皮质类固醇使用率越高。许多 Centor 评分较低的患者接受了抗生素治疗和咽喉培养。需要进一步的工作来了解急性咽炎管理的临床决策。
Zotero 插件