Evaluation of the WHO clinical decision rule for streptococcal pharyngitis.
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.
Rimoin
A W
AW
Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA. arimoin@ucla.edu
Hamza
H S
HS
Vince
A
A
Kumar
R
R
Walker
C F
CF
Chitale
R A
RA
da Cunha
A L A
AL
Qazi
S
S
Steinhoff
M C
MC
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