Engel et al reported a clinical decision rule for the diagnosis of Streptococcal pharyngitis in pediatric patients. This can help to identify a child who should have additional testing. The authors are from Groote Schuur Hospital, University of Cape Town, Stellenbosch University and University of Tennessee.
Patient selection: pediatric patient from 3 to 15 years
Parameters:
(1) tonsillar swelling
(2) tonsillar exudate
(3) rhinorrhea
(4) cough
Parameter
Finding
Points
tonsillar swelling
no
0
yes
2
tonsillar exudate
no
0
yes
1
rhinorrhea
no
1
yes
0
cough
no
1
yes
0
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score >= 3 was associated with streptococcal pharyngitis.
• Antibiotic treatment may be indicated for children with a score >= 2.
Performance:
• A score >=3 had a sensitivity of 84% and specificity of 32%, with a negative predictive value of 88%.
• The area under the ROC curve is 0.64.
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