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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