BACKGROUND: Consensus guidelines recommend against testing or treating adults at low risk for group A streptococcal (GAS) pharyngitis. OBJECTIVE: To help patients decide when to visit a clinician for the evaluation of sore throat. DESIGN: Retrospective cohort study. SETTING: A national chain of retail health clinics. PATIENTS: 71 776 patients aged 15 years or older with pharyngitis who visited a clinic from September 2006 to December 2008. MEASUREMENTS: The authors created a score using information from patient-reported clinical variables plus the incidence of local disease and compared it with the Centor score and other traditional scores that require clinician-elicited signs. RESULTS: If patients aged 15 years or older with sore throat did not visit a clinician when the new score estimated the likelihood of GAS pharyngitis to be less than 10% instead of having clinicians manage their symptoms following guidelines that use the Centor score, 230 000 visits would be avoided in the United States each year and 8500 patients with GAS pharyngitis who would have received antibiotics would not be treated with them. LIMITATION: Real-time information about the local incidence of GAS pharyngitis, which is necessary to calculate the new score, is not currently available. CONCLUSION: A patient-driven approach to pharyngitis diagnosis that uses this new score could save hundreds of thousands of visits annually by identifying patients at home who are unlikely to require testing or treatment. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention and the National Library of Medicine, National Institutes of Health.
BACKGROUND: Consensus guidelines recommend against testing or treating adults at low risk for group A streptococcal (GAS) pharyngitis. OBJECTIVE: To help patients decide when to visit a clinician for the evaluation of sore throat. DESIGN: Retrospective cohort study. SETTING: A national chain of retail health clinics. PATIENTS: 71 776 patients aged 15 years or older with pharyngitis who visited a clinic from September 2006 to December 2008. MEASUREMENTS: The authors created a score using information from patient-reported clinical variables plus the incidence of local disease and compared it with the Centor score and other traditional scores that require clinician-elicited signs. RESULTS: If patients aged 15 years or older with sore throat did not visit a clinician when the new score estimated the likelihood of GAS pharyngitis to be less than 10% instead of having clinicians manage their symptoms following guidelines that use the Centor score, 230 000 visits would be avoided in the United States each year and 8500 patients with GAS pharyngitis who would have received antibiotics would not be treated with them. LIMITATION: Real-time information about the local incidence of GAS pharyngitis, which is necessary to calculate the new score, is not currently available. CONCLUSION: A patient-driven approach to pharyngitis diagnosis that uses this new score could save hundreds of thousands of visits annually by identifying patients at home who are unlikely to require testing or treatment. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention and the National Library of Medicine, National Institutes of Health.
Authors: Stanford T Shulman; Alan L Bisno; Herbert W Clegg; Michael A Gerber; Edward L Kaplan; Grace Lee; Judith M Martin; Chris Van Beneden Journal: Clin Infect Dis Date: 2012-11-15 Impact factor: 9.079
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