Attia et al reported a clinical decision rule for children with pharyngitis and possible Group A beta-hemolytic streptococcal (GABHS) infection. The authors are from duPont Hospital for Children in Wilmington and Thomas Jefferson University.
Patient selection: pediatric patient from 6 months to 18 years of age, with acute, moderate to severe pharyngitis
Parameters:
(1) tender and enlarged cervical lymph nodes
(2) tonsillar swelling
(3) coryza
(4) scarlatiniform rash
Enlarged Nodes
Tonsillar Swelling
Coryza
Rash
Group
yes
yes
no
NA
1
yes
yes
yes
no
2
yes
no
no
no
2
no
yes
no
no
2
no
NA
yes
no
3
There are 16 combinations of the 4 tests. The rules cover 6. Presumably the other 10 are low risk or uncommon combinations.
Group
Percent GABHS
Management
1
65-95%
no testing; treat
2
15-65%
test; treat if positive
3
< 15%
no testing; no treatment
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