Komaroff et al developed a clinical strep score for predicting the probability of streptococcal pharyngitis in an adult. The authors are from Brigham and Women's Hospital, Beth Israel Hospital, Harvard University and Rhode Island Group Health Association.
Patient selection: adults with sore throat
Parameters in strep score:
(1) tonsillar exudates
(2) tonsillar enlargement
(3) anterior cervical lymph nodes
(4) myalgias
(5) previous throat culture result in past year
(6) itchy eyes
|
Parameter |
Finding |
Points |
|
tonsillar exudates |
none |
0 |
|
|
pinpoint |
1 |
|
|
marked |
2 |
|
tonsillar enlargement |
absent |
0 |
|
|
present |
1 |
|
anterior cervical lymph nodes |
not tender |
0 |
|
|
tender |
1 |
|
myalgias |
absent |
0 |
|
|
present |
1 |
|
previous isolation of Group A Streptococcus |
no |
0 |
|
|
yes |
1 |
|
itchy eyes |
no |
0 |
|
|
yes |
-1 |
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: -1
• maximum score: 6
• The higher the score the more likely that the patient has streptococcal pharyngitis.
• A score of 1 does not change the posttest probability from the pretest probability (community prevalence).
|
Score |
Pre-Test Probability |
Post-Test Probability |
|
-1 |
0 to 100 |
(0.007864 * ((pretest)^2)) + (0.1203 * (pretest)) + 1.34 |
|
0 |
0 to 100 |
(0.004386 * ((pretest)^2)) + (0.5365 * (pretest)) + 0.0419 |
|
1 |
0 to 100 |
(pretest) |
|
2 |
0 to 100 |
(-0.003824 * ((pretest)^2)) + (1.366 * (pretest)) + 0.9169 |
|
3 |
0 to 100 |
(-0.009457 * ((pretest)^2)) + (1.842 * (pretest)) + 1.486 |
|
4 |
0 to 80 |
(0.000188 * ((pretest)^3)) + (-0.0364 * ((pretest)^2)) + (2.877* (pretest)) + 1.938 |
|
4 |
> 80 |
> 95% |
|
5 |
0 to 30 |
(-0.0717 * ((pretest)^2)) + (4.441 * (pretest)) + 0.9179 |
|
5 |
30 to 80 |
(-0.005714 * ((pretest)^2)) + (1.151 * (pretest)) + 41.06 |
|
5 |
> 80 |
> 95% |
|
6 |
0 to 20 |
(-0.08134 * ((pretest)^2)) + (4.834 * (pretest)) + 5.762 |
|
6 |
20 to 70 |
(-0.01071 * ((pretest)^2)) + (1.507 * (pretest)) + 41.20 |
|
6 |
> 70 |
> 95% |
Purpose: To evaluate an adult with a sore throat using the the strep score of Komaroff et al.
Specialty: Infectious Diseases, Pedatrics, Otolaryngology
Objective: clinical diagnosis, including family history for genetics
ICD-10: J02,
