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Description

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.


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