Treating sore throats in the emergency room. The importance of follow-up in decision making.

Evaluation and treatment of emergency room patients complaining of sore throats are complicated by an unknown probability of follow-up. Tompkins' analysis of cost-effective sore throat management strategies was modified by adding an expression for variable follow-up rate. The original analysis specified a culture range when the probability of streptococcal infection was between 0.05 and 0.20, while the expanded analysis demonstrates that this range decreases with decreasing follow-up. For follow-up rates of 0.70 or less, all patients would be in either the treatment or no treatment group. This analysis demonstrates the importance of follow-up in out-patient decision making, and illustrates the methodology for including follow-up (and similar factors) in our analyses.