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CC BY-NC-ND 4.0 · J Lab Physicians 2017; 9(02): 116-120
DOI: 10.4103/0974-2727.199635
Original Article

A clinical decision rule for streptococcal pharyngitis management: An update

Hosain Nasirian
Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
,
Saeedeh TarvijEslami
Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
,
Esfandiar Matini
Department of Pediatrics, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
,
Seyedehsara Bayesh
Students' Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
,
Yasaman Omaraee
Department of Ophthalmology, Roskilde Hospital, Roskilde, Denmark
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

PURPOSE: 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.

MATERIALS AND 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.

Keywords

Erythema - exudate - lymph nodes - pharyngitis - streptococcal


Publication History

Received: 02 June 2016

Accepted: 01 September 2016

Article published online:
19 February 2020

© 2017.

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