Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score

BMC Medicine

Research Article

Conor Teljeur¹  Wai-Sun Chan²  Tom Fahey²  Kirsty K O'Brien²  Gavin A Falk²  Borislav D Dimitrov²  Jolien Aalbers³ 

[1] Department of Public Health and Primary Care, Trinity Centre, AMNCH, Dublin, Ireland;HRB Centre for Primary Care Research, Department of General Practice, RCSI Medical School, Dublin, Ireland;HRB Centre for Primary Care Research, Department of General Practice, RCSI Medical School, Dublin, Ireland;Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;

关键词: Sore Throat;    Pharyngitis;    Rheumatic Fever;    Antibiotic Prescribe;    Pretest Probability;   

DOI  :  10.1186/1741-7015-9-67

 received in 2011-03-29, accepted in 2011-06-01,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundStratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A β-haemolytic streptococcal (GABHS) pharyngitis in adults (> 14 years of age) presenting with sore throat symptoms.MethodsA systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used.ResultsA total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37).ConclusionsIndividual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care.

【 授权许可】

Unknown   
© Aalbers et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.