A streptococcal score card revisited.
OBJECTIVE
To evaluate the utility of a simple scoring system as a predictor of obtaining a positive throat culture for group A streptococci (GAS).


METHODS
Prospective descriptive study. Scores were assigned prior to the availability of the results of throat cultures.


METHODS
Emergency department and walk-in clinic of the Children's Hospital of Pittsburgh.


METHODS
Patients were 365 children between the ages of two and 16 years with acute onset of sore throat and a history of or documentation of fever within the preceding 24 hours.


METHODS
A streptococcal score was assigned on the basis of a 6-point schema in which the features were 1) age; 2) season; 3) temperature of at least 38.3 degrees C; 4) adenopathy; 5) pharyngeal erythema, edema, or exudate; and 6) no symptoms of a viral upper respiratory infection (conjunctivitis, rhinorrhea, or cough). A throat culture was performed for the isolation of GAS.


METHODS
Positive predictive value of the streptococcal score in identifying children with a positive throat culture for GAS.


RESULTS
A score of 5 or 6 predicted a positive culture for GAS in 59 and 75% of children, respectively. In patients with evidence of acute pharyngitis, the combination of age between five and 15 years, fever and absence of upper respiratory symptoms predicted a positive culture for GAS in 72% of patients.


CONCLUSIONS
The score can be used to predict the likelihood that a throat culture will be positive for GAS.
Wald
E R
ER
University of Pittsburgh School of Medicine, Pennsylvania, USA.
Green
M D
MD
Schwartz
B
B
Barbadora
K
K
D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010612:Pharyngitis / Q000382:microbiology*; D010614:Pharynx / Q000382:microbiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012621:Seasons; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes