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Diagnosing strep pharyngitis.

A simplified version of Walsh Clinical Prediction Rules was practical and accurate for helping to diagnose streptococcal pharyngitis in an inner-city, ethnically diverse clinical setting, a prospective study suggests.

Clinical prediction rules have been developed to help clinicians tease out the relatively few cases (5%-17%) of streptococcal pharyngitis from the numerous benign viral infections characterized by upper respiratory symptoms and sore throat, but these rules can be complicated, and most have not been validated in various populations, reported Dr. Thomas G. McGinn of Mount Sinai School of Medicine, New York, and his colleagues.

The rules typically require the assignment of various weights to predictive factors. But many physicians simply count the predictors and give them equal weights.

In an effort to validate this simplified approach, the investigators used cough, fever, tonsillar or pharyngeal exudates, cervical lymphadenopathy, and known exposure as equal predictors of infection. Each predictor was worth 1 point, with the exception of cough, which was worth -1 point because of its association with absence of the infection.

In 166 patients with a streptococcal pharyngitis prevalence of 24%, the predictors were accurate for estimating the probability of a positive culture. Receiver operating characteristic curves and areas under the curves were similar for the simplified rules (0.71) and the original Walsh method (0.81), the investigators said (Mayo Clin. Proc. 78[3]:289-93, 2003).

Use of this simplified clinical prediction approach in diagnosing streptococcal pharyngitis could potentially improve the identification of these infections, limit the need for throat swabs in patients presenting with sore throat, and reduce unnecessary antibiotic use in patients with viral infections, the investigators concluded.
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Title Annotation:Clinical Capsules
Author:Worcester, Sharon
Publication:Internal Medicine News
Article Type:Brief Article
Date:Sep 1, 2003
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