Smeesters et al report a clinical decision rule for evaluating a pediatric patient with pharyngitis. This can help to reduce unnecessary antibiotic therapy in children with a viral illness. The authors are from Universidade de Brasilia, Hopital Universitaire des Enfants Reine Fabiola, Universite Libre de Bruxelles and Hospital Regional da Asa Sul (Brazil)
Patient selection: <= 15 years old with pharyngitis
Parameters:
(1) age in years
(2) number of viral signs
(3) number of bacterial signs
Viral Sign |
Finding |
Points |
conjunctivitis |
absent |
0 |
|
present |
1 |
coryza |
absent |
0 |
|
present |
1 |
cough |
absent |
0 |
|
present |
1 |
diarrhea |
absent |
0 |
present |
1 |
|
viral-like exanthema |
absent |
0 |
|
present |
1 |
number of viral signs =
= SUM(points for all 5 parameters)
Bacterial Sign |
Finding |
Points |
tender cervical lymph nodes |
absent |
0 |
|
present |
1 |
headache |
absent |
0 |
|
present |
1 |
petechiae on palate |
absent |
0 |
|
present |
1 |
fever > 38.5°C |
absent |
0 |
|
present |
1 |
abdominal pain |
absent |
0 |
|
present |
1 |
acute onset (< 12 hours) |
absent |
0 |
|
present |
1 |
number of bacterial signs =
= SUM(points for all 6 parameters)
Parameter |
Finding |
Points |
age |
<= 35 months |
20 |
|
36-59 months |
6 |
|
>= 60 months |
2 |
viral signs |
0 |
0 |
|
1 |
7 |
|
>= 2 |
10 |
bacterial signs |
0 |
10 |
|
1 |
-2 |
|
>= 2 |
-4 |
total score =
=- SUM(points for all 3 parameters)
Interpretation:
• minimum score: -4
• maximum score: 40
Total Score |
No Bacterialogical Resources |
Culture Available |
< 5 |
antibiotic |
antibiotic |
5 to 7 |
antibiotic |
antibiotic if culture positive |
>= 8 |
symptomatic |
symptomatic |
Performance:
• The specificity for pharyngitis not due to group A Streptococcus was 84% but sensitivity was 41%. The post-test probability for a score >= 8 was 88% in the study group.
Specialty: Infectious Diseases