Pharyngitis diagnostic study of choice: Difference between revisions
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The various investigations must be performed in the following order: | The various investigations must be performed in the following order: | ||
'''Centor criteria'''<br>The original Center score uses four signs and symptoms to estimate the probability of acute [[streptococcal]] [[pharyngitis]] in adults with a [[sore throat]] The score was later modified by adding age. It is important to evaluate for a definitive diagnosis to exclude [[Group A streptococcal infection|GAS]] and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither [[microbiologic]] tests nor [[antimicrobial]] therapy is necessary. The Center score to use for children and adults with a [[sore throat]] to estimate the probability of [[Streptococcus]] pyogenes infection. | '''Centor criteria'''<br>The original Center score uses four signs and symptoms to estimate the probability of acute [[streptococcal]] [[pharyngitis]] in adults with a [[sore throat]] The score was later modified by adding age. It is important to evaluate for a definitive diagnosis to exclude [[Group A streptococcal infection|GAS]] and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither [[microbiologic]] tests nor [[antimicrobial]] therapy is necessary. The Center score to use for children and adults with a [[sore throat]] to estimate the probability of [[Streptococcus]] pyogenes infection. | ||
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Revision as of 20:02, 23 December 2020
Overview
Diagnostic tests provided include throat culture and checking for rapid antigen detection. Although the sensitivity and specificity of rapid antigen detection testing have improved dramatically, a throat culture is considered the diagnostic standard. It is possible to use the adjusted Centor score to help doctors determine which patients do not need testing, throat culture/rapid antigen detection testing, or empirical antibiotic therapy.
Diagnostic Study of Choice
Study of choice
The diagnostic study of choice for bacterial pharyngitis is the throat culture. A single-swab throat culture is 90 to 95 percent sensitive with proper sampling and plating techniques.[1] [2]
The comparison of various diagnostic studies for bacterial pharyngitis
| Test | Sensitivity | Specificity |
|---|---|---|
| Test 1 | ...% | ...% |
| Test 2 | ...% | ...% |
[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity
Diagnostic results
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
- [Finding 1]
- [Finding 2]
Sequence of Diagnostic Studies
The various investigations must be performed in the following order:
Centor criteria
The original Center score uses four signs and symptoms to estimate the probability of acute streptococcal pharyngitis in adults with a sore throat The score was later modified by adding age. It is important to evaluate for a definitive diagnosis to exclude GAS and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither microbiologic tests nor antimicrobial therapy is necessary. The Center score to use for children and adults with a sore throat to estimate the probability of Streptococcus pyogenes infection.
| Modified Centor criteria | Appropriate management according to the total score | ||||
| Criteria | Points | Total score | Chance of streptococcal infection in community
with usual levels of infection, % |
Suggested management | |
| Fever (temperature > 38°C) | +1 | 0 | 2-3% | No culture or antibiotic is required | |
| Absence of cough | +1 | 1 | 4-6% | ||
| Swollen and tender anterior cervical nodes | +1 | 2 | 10-12% | RADT or Culture and treat only if culture result is positive | |
| Tonsillar swelling or exudates | +1 | 3 | 27-28% | ||
| Age 3–14 yr | +1 | 4 | 38–63% | Culture all and treat emperically with penicillin on clinical grounds | |
| Age 15–44 yr | 0 | ||||
| Age ≥ 45 yr | -1 | ||||
Name of Diagnostic Criteria
It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
OR
IF there are clear, established diagnostic criteria
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
IF there are no established diagnostic criteria
There are no established criteria for the diagnosis of [disease name].
References
- ↑ Sykes EA, Wu V, Beyea MM, Simpson M, Beyea JA (April 2020). "Pharyngitis: Approach to diagnosis and treatment". Can Fam Physician. 66 (4): 251–257. PMC 7145142 Check
|pmc=value (help). PMID 32273409 Check|pmid=value (help). Vancouver style error: initials (help) - ↑ Vazquez MN, Sanders JE (December 2017). "Diagnosis and management of group A streptococcal pharyngitis and associated complications". Pediatr Emerg Med Pract. 14 (12): 1–20. PMID 29185672.