Pecina Jennifer L, Nigon Leah M, Penza Kristine S, Murray Martha A, Kronebusch Beckie J, Miller Nathaniel E, Jensen Teresa B
Department of Family Medicine, Mayo Clinic, Rochester, MN, United States.
Department of Nursing, Mayo Clinic, Rochester, MN, United States.
J Med Internet Res. 2021 Dec 20;23(12):e25899. doi: 10.2196/25899.
The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing.
We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters.
This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits.
There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test.
McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.
麦基萨克标准是一种经过验证的评分系统，用于确定急性咽痛由A组链球菌（GAS）引起的可能性，以便对需要进行链球菌检测的患者进行分层。
我们旨在比较面对面（f2f）和非面对面就诊时获得的麦基萨克标准。
这项回顾性研究比较了在护士规程电话问诊、电子就诊（e-visit）和面对面门诊就诊期间计算的麦基萨克评分中GAS检测阳性的百分比。
对于任何麦基萨克评分，不同就诊类型之间的链球菌检测阳性百分比没有差异。与面对面就诊相比，电话问诊和电子就诊中缺失任何评分组成部分的情况明显更多。对于单个评分组成部分，与电话问诊和面对面就诊相比，电子就诊中缺失发热和咳嗽信息的情况明显更少。与电话问诊和电子就诊相比，面对面就诊中扁桃体和淋巴结病描述缺失的可能性明显更小。在所有就诊类型中，麦基萨克评分为4的患者GAS阳性率为55%至68%。有4次问诊没有缺失任何评分组成部分，麦基萨克评分为0。这4次问诊中没有一次GAS检测呈阳性。
如果存在检测的重大障碍，如新冠疫情或地理障碍，在非面对面护理期间收集的麦基萨克评分为4可用于考虑对GAS进行经验性治疗而无需检测。未来的研究应进一步评估麦基萨克评分为0的非面对面问诊是否可以安全地排除在GAS检测之外。
