title: Evaluation of the WHO clinical decision rule for streptococcal pharyngitis.
abstract: OBJECTIVE
  To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS) pharyngitis in three countries.
  
  
  METHODS
  A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2-12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis.
  
  
  RESULTS
  The proportion of children presenting with sore throat and found to have GABHS pharyngitis ranged from 24.6% (Brazil) to 42.0% (Croatia). WHO CDR sensitivity was low for all sites in both age groups. In children age 5 or older, sensitivity ranged from 3.8% in Egypt to 10.8% in Brazil. In children under 5, sensitivity was low (0.0-4.6%) Specificity was high in both age groups in all countries (93.8-97.4%).
  
  
  CONCLUSIONS
  In these populations, the current WHO CDR has high specificity, but low sensitivity; it did not detect up to 96.0% of children who have laboratory confirmed GABHS pharyngitis. A CDR with higher sensitivity should be developed for use in regions where rheumatic fever and rheumatic heart disease are still major health problems.
authors.affiliation: Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA. arimoin@ucla.edu
authors.forename: A W
authors.initials: AW
authors.lastname: Rimoin
authors.forename: H S
authors.initials: HS
authors.lastname: Hamza
authors.forename: A
authors.initials: A
authors.lastname: Vince
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.forename: C F
authors.initials: CF
authors.lastname: Walker
authors.forename: R A
authors.initials: RA
authors.lastname: Chitale
authors.forename: A L A
authors.initials: AL
authors.lastname: da Cunha
authors.forename: S
authors.initials: S
authors.lastname: Qazi
authors.forename: M C
authors.initials: MC
authors.lastname: Steinhoff
mesh_terms: D001938:Brazil; D002648:Child; D002675:Child, Preschool; D017523:Croatia; D003657:Decision Making; D004534:Egypt; D006801:Humans; D010612:Pharyngitis / Q000175:diagnosis* / Q000382:microbiology*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012372:ROC Curve; D012213:Rheumatic Fever / Q000517:prevention & control; D012214:Rheumatic Heart Disease / Q000517:prevention & control; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D014944:World Health Organization