Parameters used for score:
(1) age of the patient
(2) temperature
(3) cough
(4) tender anterior cervical adenopathy
(5) tonsillar swelling and/or exudate
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
3 – 14 years
|
1
|
|
|
15 – 44 years
|
0
|
|
|
>= 45 years
|
-1
|
|
temperature
|
> 38°C
|
1
|
|
|
<= 38°C
|
0
|
|
cough
|
present
|
0
|
|
|
absent
|
1
|
|
tender anterior cervical adenopathy
|
present
|
1
|
|
|
absent
|
0
|
|
tonsillar swelling or exudate
|
present
|
1
|
|
|
absent
|
0
|
where:
• Parameters 2 to 5 are the same as Centor et al.
• Children < 3 years of age are not included. In the implementation I have assigned 0 points for this group.
clinical score =
= SUM(points for all 5 parameters)
If the score is –1, then the final score is increased to 0.
If the score is 5, then the final score is decreased to 4.
final clinical score =
= MIN(4, MAX(0, score))
Interpretation:
• minimum final score: 0
• maximum final score: 4
• The higher the score, the more likely the possibility of a streptococcal pharyngitis.
|
Score
|
Chance Streptococcal Infection
|
Culture
|
Therapy
|
|
0
|
2-3%
|
No
|
No
|
|
1
|
4-6%
|
No
|
No
|
|
2
|
10-12%
|
All
|
If culture positive
|
|
3
|
27-28%
|
All
|
If culture positive
|
|
4
|
38-63%
|
All
|
Based on clinical grounds
|
from Table page 79, McIsaac (1998)
where:
• The chance for streptococcal infection is based on usual community levels. During an epidemic the chance would be higher.
• Clinical grounds to treat: If the patient has a high temperature or is clinically unwell, and presents early in disease course.
• Suggested antibiotic regimen for treatment: erythromycin if penicillin allergic, else penicillin.
