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

Hdl Handle:
http://hdl.handle.net/10147/135363
Title:
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
Authors:
Aalbers, Jolien; O'Brien, Kirsty K; Chan, Wai-Sun; Falk, Gavin A; Teljeur, Conor; Dimitrov, Borislav D; Fahey, Tom
Citation:
BMC Medicine. 2011 Jun 01;9(1):67
Issue Date:
1-Jun-2011
URI:
http://hdl.handle.net/10147/135363
Abstract:
Abstract Background Stratifying 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. Methods A 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. Results A 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). Conclusions Individual 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.
Item Type:
Journal Article

Full metadata record

DC FieldValue Language
dc.contributor.authorAalbers, Jolien-
dc.contributor.authorO'Brien, Kirsty K-
dc.contributor.authorChan, Wai-Sun-
dc.contributor.authorFalk, Gavin A-
dc.contributor.authorTeljeur, Conor-
dc.contributor.authorDimitrov, Borislav D-
dc.contributor.authorFahey, Tom-
dc.date.accessioned2011-07-05T15:26:20Z-
dc.date.available2011-07-05T15:26:20Z-
dc.date.issued2011-06-01-
dc.identifierhttp://dx.doi.org/10.1186/1741-7015-9-67-
dc.identifier.citationBMC Medicine. 2011 Jun 01;9(1):67-
dc.identifier.urihttp://hdl.handle.net/10147/135363-
dc.description.abstractAbstract Background Stratifying 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. Methods A 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. Results A 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). Conclusions Individual 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.-
dc.titlePredicting Streptococcal Pharyngitis in Adults in Primary Care: A Systematic Review of the Diagnostic Accuracy of Symptoms and Signs and Validation of the Centor Score-
dc.typeJournal Article-
dc.language.rfc3066en-
dc.rights.holderAalbers et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2011-06-30T13:04:32Z-
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