II. Indications

III. Criteria: Modified Centor (recommended)

  1. Tonsillar exudate or erythema
  2. Anterior cervical adenopathy
  3. Cough absent
  4. Fever present
  5. Age
    1. Age 3 to 14 years: +1 point
    2. Age 15 to 45 years: 0 points
    3. Age over 45 years: -1 points

IV. Approach: Clinical Suspicion based on scoring above

  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
  3. Strep Score 0 to 1
    1. Provide Pharyngitis Symptomatic Treatment

V. 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. Reference
    1. Centor (1990) in Sox (1990) Common Diagnostic, p.247
  3. 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]

VI. Interpretation (Clinic and ER probability based on original criteria)

  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)

VII. 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