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Arch Pediatr Adolesc Med. 2001 Jun;155(6):687-91.

Performance of a predictive model for streptococcal pharyngitis in children.

Author information

1
Department of Pediatrics, Alfred I. Dupont Hospital for Children, Wilmington, Deleware, USA.

Erratum in

  • Arch Pediatr Adolesc Med 2001 Oct;155(10):1179.

Abstract

CONTEXT:

Group A beta-hemolytic streptococcus (GABHS) pharyngitis is a common childhood illness. The clinical diagnosis is difficult to determine and laboratory tests have limitations; hence, the condition is generally overdiagnosed and overtreated. Several clinical pediatric-specific predictive models have been published but none have been prospectively studied.

OBJECTIVE:

To test the performance of a previously published predictive model for GABHS pharyngitis in children in different clinical settings and during different seasons.

DESIGN:

Prospective cohort study.

SETTINGS:

Pediatric emergency department and 2 pediatric outpatient clinics.

PATIENTS:

Children aged between 1 and 18 years with pharyngitis on initial examination at study sites between April 1, 1999, and March 31, 2000.

INTERVENTIONS:

Recording of clinical features during initial evaluation using a standardized form and recovery of GABHS from patients' throats using reference standard methods.

MAIN OUTCOME MEASURES:

Posttest probability for GABHS positive throat culture associated with the model's positive predictors (moderate to severe tonsillar swelling, cervical lymphadenopathy [moderate to severe tenderness and enlargement of cervical lymph nodes], scarletiniform rash, and the absence of coryza) and the models' negative predictors (absence of the above signs and the presence of coryza).

RESULTS:

Of 587 patients analyzed, 218 (37%) had a positive throat culture for GABHS. Forty-nine percent were boys. Mean +/- SD age was 6.7 +/- 3.9 years. There was no difference between the subsets within the sample. The posttest probability values for a positive throat culture associated with positive and negative predictors of the model were 79% and 12%, respectively.

CONCLUSIONS:

A pediatric predictive model for GABHS pharyngitis performed better than physicians' subjective estimates for a positive throat culture and was comparable with a rapid antigen detection test. The model performed consistently well in different populations and across seasons. It can be useful if reliable microbiological testing and/or follow-up are not attainable.

PMID:
11386959
[Indexed for MEDLINE]

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