Streptococcal Clinical Score of Wald et al for Group A Streptococcal Pharyngitis

 

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.