A simple score based on clinical findings can predict a positive culture for Group A Streptococcus in pediatric patients with a sore throat. The study was done at the University of Pittsburgh and the Children's Hospital of Pittsburgh in Pennsylvania.
Population studied:
(1) children aged 2-16 years
(2) attending a walk-in clinic or emergency department
Parameters:
(1) age of patient
(2) season of the year
(3) fever
(4) adenopathy
(5) pharyngitis
(6) upper respiratory symptoms
Parameter |
Finding |
Points |
age |
< 5 years of age |
0 |
|
5 – 15 years of age |
1 |
|
> 15 years of age |
0 |
season of the year |
November to May |
1 |
|
June to October |
0 |
fever |
temperature >= 38.3°C |
1 |
|
temperature < 38.3°C |
0 |
adenopathy |
present |
1 |
|
absent |
0 |
pharyngitis |
present |
1 |
|
absent |
0 |
upper respiratory symptoms |
present |
0 |
|
absent |
1 |
where:
• adenopathy: cervical lymph nodes >= 1 cm OR cervical lymph nodes tender to palpation
• pharyngitis: erythema OR swelling OR exudate of pharynx or tonsils
• upper respiratory symptoms: rhinorrhea OR cough OR conjunctivitis
streptococcal clinical score =
= SUM(points for the 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• A score = 5 predicts a positive culture for Group A Streptococcus in 59% of patients.
• A score = 6 predicts a positive culture for Group A Streptococcus in 75% of patients.
• Presence of age 5-15 years, temperature >= 38.3°C, pharyngitis, AND absence of upper respiratory symptoms (negative for season and adenopathy) predicted a positive culture for Group A Streptococcus in 72% of patients.
Streptococcal Score |
Positive Cultures |
1 |
0 |
2 |
4/17 (24%) |
3 |
11/49 (22%) |
4 |
49/118 (41%) |
5 |
76/128 (59%) |
6 |
40/53 (75%) |
Limitations:
• Inclusion of a concurrent family history or contact with another child with Group A Streptococcal pharyngitis might be interesting.
• A pharyngeal culture for Group A streptococcus has several limitations, including the quality of specimen collection and the number of organisms present.
Specialty: Infectious Diseases, Pedatrics, Otolaryngology
ICD-10: ,