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Aten Primaria. 2007 Jul;39(7):361-5.

[Is streptococcal pharyngitis diagnosis possible?].

[Article in Spanish]

Author information

1
Centro de Salud San Fernando 2, San Fernando de Henares, Madrid, Spain. jmarin29@hotmail.com

Abstract

OBJECTIVE:

To determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab).

DESIGN:

Descriptive study.

SETTING:

San Fernando 2 Health Centre, Madrid (outer urban area), Spain.

PARTICIPANTS:

On hundred forty patients over 14 years old who had a "sore throat" as main symptom and attended clinic between 14 February and 12 May, 2005.

MAIN MEASUREMENTS:

Sensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method.

RESULTS:

Thirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology.

CONCLUSIONS:

The high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty. What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic).

PMID:
17669320
DOI:
10.1157/13107724
[Indexed for MEDLINE]
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