title: A clinical decision rule for streptococcal pharyngitis management: An update.
abstract: OBJECTIVE
  Group A streptococcal (GAS) pharyngitis is a common disease worldwide. We aimed to establish a pragmatic program as a clinical decision rule for GAS pharyngitis diagnosis.
  
  
  METHODS
  This article derived from a research project on children aged 6-15 years. Five hundred and seventy-one children met the enrollment criteria on whom throat culture and validities of clinical findings were assessed in positive and negative throat culture groups.
  
  
  RESULTS
  Positive GAS throat culture group included 99 (17.3%) patients with a positive culture. Negative GAS throat culture group included 472 (82.6%) patients. Exudate or enlarged tender nodes each one had 63% and 68% sensitivity and 31.5% and 37.5% specificity with a high percentage of negative predictive value (NPV) 80.54% and 85.09%, respectively. Sequence test revealed validities of exudate plus enlarged nodes at 43.62% sensitivity and 57.19% specificity with 83% NPV.
  
  
  CONCLUSIONS
  High NPV of 83% indicated that similar prevalence in the absence of either exudate or enlarged tender lymph nodes. Probability of GAS negative throat cultures among children suspected of GAS pharyngitis was 83% and would correctly not receive inopportune antibiotics.
authors.affiliation: Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran.
authors.forename: Hosain
authors.initials: H
authors.lastname: Nasirian
authors.affiliation: Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran.
authors.forename: Saeedeh
authors.initials: S
authors.lastname: TarvijEslami
authors.affiliation: Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran.
authors.forename: Esfandiar
authors.initials: E
authors.lastname: Matini
authors.affiliation: Students' Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
authors.forename: Seyedehsara
authors.initials: S
authors.lastname: Bayesh
authors.affiliation: Department of Ophthalmology, Roskilde Hospital, Roskilde, Denmark.
authors.forename: Yasaman
authors.initials: Y
authors.lastname: Omaraee
keywords: Erythema; exudate; lymph nodes; pharyngitis; streptococcal