Strep Score

Aka: Strep Score, Walsh Pharyngitis Criteria, McIsaac Decision Rule, Modified Centor Criteria

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II. Indications

  1. Group A Streptococcal Pharyngitis Diagnosis

III. Criteria: Modified Centor Criteria (McIsaac Scoring, recommended)

  1. Centor Criteria (one point for each of 4 criteria)
    1. Tonsillar exudate or erythema
    2. Swollen, tender anterior cervical adenopathy
    3. Cough absent
    4. Fever present (>100.4 F or >38 C)
  2. Age (modifier added in McIsaac Criteria)
    1. Age 3 to 14 years: +1 point
    2. Age 15 to 45 years: 0 points
    3. Age over 45 years: -1 points
  3. Interpretation (McIsaac = Centor + Age Modifier)
    1. Strep Score 4 to 5 (or Strep Score 2 if patient unreliable)
      1. Treat with Antibiotics
    2. Strep Score 2 to 3: Perform rapid Antigen test
      1. Antigen test positive: Treat with Antibiotics
      2. Antigen test negative: Throat Culture (not needed if strep testing via PCR)
    3. Strep Score 0 to 1
      1. Provide Pharyngitis Symptomatic Treatment

IV. Criteria: Older, original criteria with derivation (1 point for each clinical finding)

  1. Original Criteria (interpretation below based on these)
    1. Tonsillar exudate
    2. Tender, anterior cervical adenopathy
    3. Cough absent
    4. Fever present
  2. Modifiers (Not included in interpretation below)
    1. McIsaac Decision Rule modifier
      1. Age younger than 15 years: +1 point
      2. Age 15 to 45 years: 0 points
      3. Age over 45 years: -1 points
      4. McIsaac (2000) CMAJ 163:811-5 [PubMed]
    2. Exposure to known Pharyngitis contact
      1. Added with Walsh Clinical Prediction Rules
      2. McGinn (2003) Mayo Clin Proc 78:289-93 [PubMed]
  3. Interpretation (Original Centor criteria without modifiers (clinic and ER probability)
    1. Based on original criteria above
    2. Score 0: Streptococcus probability 1% (3% in ER)
    3. Score 1: Streptococcus probability 4% (8% in ER)
    4. Score 2: Streptococcus probability 9% (18% in ER)
    5. Score 3: Streptococcus probability 21% (38% in ER)
    6. Score 4: Streptococcus probability 43% (63% in ER)
  4. References
    1. Centor (1990) in Sox (1990) Common Diagnostic, p.247

V. References

  1. Centor (1990) in Sox (1990) Common Diagnostic, p.247
  2. Sloane (1998) Family Medicine, p. 629

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Related Studies

Ontology: Streptococcal sore throat (C0036689)

Concepts Disease or Syndrome (T047)
ICD9 034.0
ICD10 J02.0
SnomedCT 154302004, 186358002, 186360000, 186361001, 43878008
English Streptococcal sore throat NOS, streptococcal sore throat, streptococcal sore throat (diagnosis), Pharyngitis streptococcal, Strep sore throat, Septic pharyngitis, strep throats, strept throat, streptococcal angina, streptococcus pharyngitis, Pharyngitis;streptococcal, Sore throat;streptococcal, septic sore throat, strep throat, Strep Throat, Streptococcal angina (disorder), Streptococcal sore throat NOS (disorder), Streptococcal pharyngitis (disorder), Streptococcal sore throat, Streptococcal pharyngitis, Septic sore throat, Streptococcal angina, Strep throat, Strept throat, Streptococcal sore throat (disorder), pharyngitis; septic, pharyngitis; streptoccocal, septic; pharyngitis, septic; sore throat, sore throat; septic, sore throat; streptoccocal, streptoccocal; pharyngitis, streptoccocal; sore throat, Septic sore throat due to streptococcal infection, streptococcal pharyngitis
Spanish faringitis estreptocócica, faringitis estreptocócica (trastorno), Infección estreptocócica de garganta, dolor de garganta séptico, dolor de garganta estreptocócico, dolor de garganta estreptocócico (trastorno), angina estreptocócica, SAI (trastorno), angina estreptocócica, SAI, dolor de garganta por estreptococo, SAI, angina estreptocócica, Faringitis estreptocócica
Italian Faringite streptococcica, Angina streptococcica
Dutch streptokokkenangina, Streptokokken-angina, faryngitis; septisch, faryngitis; streptokokken, keelpijn; septisch, keelpijn; streptokokken, septisch; faryngitis, septisch; keelpijn, streptokokken; faryngitis, streptokokken; keelpijn, Streptokokkenfaryngitis, streptokokkenfaryngitis
French Angine streptococcique, Pharyngite streptococcique
German Halsschmerzen durch Streptokokken, Streptokokken-Pharyngitis, Pharyngitis durch Streptokokken
Japanese レンサ球菌性咽頭炎, レンサ球菌性咽喉痛, ﾚﾝｻｷｭｳｷﾝｾｲｲﾝｺｳﾂｳ, ﾚﾝｻｷｭｳｷﾝｾｲｲﾝﾄｳｴﾝ
Czech Streptokoková faryngitida, Streptokoková angína
Korean 사슬알균성 인두염
Hungarian streptococcus pharyngitis, streptococcus torokgyulladás, streptococcalis pharyngitis
Portuguese Faringite estreptocócica
Derived from the NIH UMLS (Unified Medical Language System)

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