Should nurses in Israeli primary care clinics be expected to manage streptococcal throat infections?
BACKGROUND
Legal regulations in Israel allow nurses to perform only limited clinical procedures.


OBJECTIVE
To determine the probability of streptococcal infection in adults with sore throat, as assessed clinically by standard nursing procedures.


METHODS
Using throat culture as the standard, the contribution of various clinical findings (fever, exudate, erythrocyte sedimentation rate (ESR), white blood count) to the determination of the diagnosis of streptococcal infection was assessed, using logistic regression analysis.


METHODS
Israeli general practice.


METHODS
100 consecutive adult patients presenting with a red, sore throat.


RESULTS
Six patients showed the full clinical picture of exudate, increased ESR and leukocytosis, with an 82% probability of streptococcal infection. Forty-nine patients showed none of these three findings, and only one of them (among the three patients with rhinitis) had a positive throat swab. Forty-five patients showed an intermediate clinical picture which did not provide a reliable basis for the diagnosis or exclusion of streptococcal infection. Fever alone did not significantly (P < 0.05) predict streptococcal infection.


CONCLUSIONS
Nurses may safely discharge adult patients with a red, sore throat without antibiotic treatment only if they have no additional signs or symptoms. The few patients with all the clinical findings may be treated with antibiotics without a throat swab. All other patients should be referred for examination by a doctor.
D000293:Adolescent; D000328:Adult; D000368:Aged; D005194:Family Practice; D005260:Female; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods*; D015403:Nursing Evaluation Research; D010612:Pharyngitis / Q000382:microbiology* / Q000451:nursing; D017009:Professional Autonomy; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000382:microbiology* / Q000451:nursing; D014218:Triage / Q000379:methods