Mark C Steinhoff1, Christa Fischer Walker, Anne W Rimoin, Hala S Hamza. 1. Department of International Health, Bloomberg School of Public Health, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. msteinho@jhsph.edu
Abstract
BACKGROUND: Most of the world's children live in regions where laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians' decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. METHODS: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. RESULTS: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92% sensitivity and 38% specificity in these children. CONCLUSIONS: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90% of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.
BACKGROUND: Most of the world's children live in regions where laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians' decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. METHODS: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. RESULTS: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92% sensitivity and 38% specificity in these children. CONCLUSIONS: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90% of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.
Authors: Mark E Engel; Karen Cohen; Ronald Gounden; Andre P Kengne; Dylan Dominic Barth; Andrew C Whitelaw; Veronica Francis; Motasim Badri; Annemie Stewart; James B Dale; Bongani M Mayosi; Gary Maartens Journal: Pediatr Infect Dis J Date: 2017-03 Impact factor: 2.129
Authors: Aurelino Rocha Barbosa Júnior; Cláudia Di Lorenzo Oliveira; Maria Jussara Fernandes Fontes; Laura Maria de Lima Bezário Facury Lasmar; Paulo Augusto Moreira Camargos Journal: Rev Paul Pediatr Date: 2014-12
Authors: Matthew M Coates; Karen Sliwa; David A Watkins; Liesl Zühlke; Pablo Perel; Florence Berteletti; Jean-Luc Eiselé; Sheila L Klassen; Gene F Kwan; Ana O Mocumbi; Dorairaj Prabhakaran; Mahlet Kifle Habtemariam; Gene Bukhman Journal: Lancet Glob Health Date: 2021-05-10 Impact factor: 38.927