title: Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study.
abstract: OBJECTIVE
  To document whether elements of a structured history and examination predict adverse outcome of acute sore throat.
  
  
  METHODS
  Prospective clinical cohort.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  14,610 adults with acute sore throat (≤ 2 weeks' duration).
  
  
  METHODS
  Common suppurative complications (quinsy or peritonsillar abscess, otitis media, sinusitis, impetigo or cellulitis) and reconsultation with new or unresolving symptoms within one month.
  
  
  RESULTS
  Complications were assessed reliably (inter-rater κ=0.95). 1.3% (177/13,445) of participants developed complications overall and 14.2% (1889/13,288) reconsulted with new or unresolving symptoms. Independent predictors of complications were severe tonsillar inflammation (documented among 13.0% (1652/12,717); odds ratio 1.92, 95% confidence interval 1.28 to 2.89) and severe earache (5% (667/13,323); 3.02, 1.91 to 4.76), but the model including both variables had modest prognostic utility (bootstrapped area under the receiver operator curve 0.61, 0.57 to 0.65), and 70% of complications (124/177) occurred when neither was present. Clinical prediction rules for bacterial infection (Centor criteria and FeverPAIN) also predicted complications, but predictive values were also poor and most complications occurred with low scores (67% (118/175) scoring ≤ 2 for Centor; 126/173 (73%) scoring ≤ 2 for FeverPAIN). Previous medical problems, sex, temperature, and muscle aches were independently but weakly associated with reconsultation with new or unresolving symptoms.
  
  
  CONCLUSIONS
  Important suppurative complications after an episode of acute sore throat in primary care are uncommon. History and examination and scores to predict bacterial infection cannot usefully identify those who will develop complications. Clinicians will need to rely on strategies such as safety netting or delayed prescription in managing the uncertainty and low risk of complications.
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: Chris C
authors.initials: CC
authors.lastname: Butler
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
authors.forename: John
authors.initials: J
authors.lastname: Campbell
authors.forename: Brendan
authors.initials: B
authors.lastname: Delaney
authors.forename: Sue
authors.initials: S
authors.lastname: Broomfield
authors.forename: Paula
authors.initials: P
authors.lastname: Barratt
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Hazel
authors.initials: H
authors.lastname: Everitt
authors.forename: Mark
authors.initials: M
authors.lastname: Mullee
authors.forename: Ian
authors.initials: I
authors.lastname: Williamson
authors.forename: David
authors.initials: D
authors.lastname: Mant
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
mesh_terms: D000038:Abscess / Q000382:microbiology*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019540:Area Under Curve; D002481:Cellulitis / Q000382:microbiology; D004433:Earache / Q000382:microbiology*; D005260:Female; D006801:Humans; D007169:Impetigo / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010035:Otitis Media, Suppurative / Q000382:microbiology; D014066:Palatine Tonsil; D010612:Pharyngitis / Q000150:complications* / Q000188:drug therapy; D011320:Primary Health Care; D011446:Prospective Studies; D012372:ROC Curve; D012852:Sinusitis / Q000382:microbiology; D014069:Tonsillitis / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents