title: Pharyngitis clinical prediction rules: effect of interobserver agreement: a MetroNet study.
abstract: OBJECTIVE
  Pharyngitis clinical prediction rules improve Group A beta-hemolytic streptococcus (GABHS) diagnosis and decrease unnecessary antibiotic use, yet few studies have addressed clinician variability in assessment of sore throat signs and symptoms.
  
  
  METHODS
  We conducted a cross-sectional study in which two clinicians examined each of 200 adult sore throat patients. Each patient had a rapid GABHS antigen test. Clinicians were blinded to each other's assessment and to the rapid antigen result. Interobserver agreement was estimated using a kappa coefficient. Effect of agreement on sensitivity, specificity, and hypothetic rapid antigen testing and antibiotic prescribing was determined for two clinical prediction rules.
  
  
  RESULTS
  We found moderate inter-rater reliability on sore throat history and physical assessments. Clinician agreement was associated with significantly fewer hypothetic rapid antigen tests performed.
  
  
  CONCLUSIONS
  Interobserver agreement enhances the utility of pharyngitis clinical prediction rules. Medical school and residency training should focus on correct assessment of history and physical examination components used in GABHS clinical prediction rules. Correct assessment will result in less GABHS testing and antibiotic prescriptions for sore throat patients.
authors.affiliation: Division of Practice-Based Research, Department of Family Medicine, Wayne State University, 101 East Alexandrine, Detroit, MI 48201, USA. kensch@med.wayne.edu
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.forename: Joseph
authors.initials: J
authors.lastname: Monsur
authors.forename: Justin
authors.initials: J
authors.lastname: Northrup
authors.forename: Patricia
authors.initials: P
authors.lastname: West
authors.forename: Anne Victoria
authors.initials: AV
authors.lastname: Neale
mesh_terms: D000208:Acute Disease; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D008487:Medical History Taking; D015588:Observer Variation; D010612:Pharyngitis / Q000175:diagnosis* / Q000382:microbiology; D010808:Physical Examination; D010821:Physicians, Family; D013290:Streptococcal Infections / Q000175:diagnosis*