title: Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review.
abstract: OBJECTIVE
  To conduct a systematic review to determine whether clinical findings can be used to rule in or to rule out streptococcal pharyngitis in children.
  
  
  METHODS
  Two authors independently searched MEDLINE and EMBASE. We included articles if they contained data on the accuracy of symptoms or signs of streptococcal pharyngitis, individually or combined into prediction rules, in children 3-18 years of age.
  
  
  RESULTS
  Thirty-eight articles with data on individual symptoms and signs and 15 articles with data on prediction rules met all inclusion criteria. In children with sore throat, the presence of a scarlatiniform rash (likelihood ratio [LR], 3.91; 95% CI, 2.00-7.62), palatal petechiae (LR, 2.69; CI, 1.92-3.77), pharyngeal exudates (LR, 1.85; CI, 1.58-2.16), vomiting (LR, 1.79; CI, 1.58-2.16), and tender cervical nodes (LR, 1.72; CI, 1.54-1.93) were moderately useful in identifying those with streptococcal pharyngitis. Nevertheless, no individual symptoms or signs were effective in ruling in or ruling out streptococcal pharyngitis.
  
  
  CONCLUSIONS
  Symptoms and signs, either individually or combined into prediction rules, cannot be used to definitively diagnose or rule out streptococcal pharyngitis.
authors: University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, Pittsburgh, PA 15224, USA. nader.shaikh@chp.edu
authors: Nader
authors: N
authors: Shaikh
authors: Nithya
authors: N
authors: Swaminathan
authors: Emma G
authors: EG
authors: Hooper
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D006801:Humans; D010612:Pharyngitis / Q000175:diagnosis / Q000382:microbiology*; D010808:Physical Examination; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes