Exam
Strep Score
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Strep Score
, Walsh Pharyngitis Criteria, McIsaac Decision Rule, Modified Centor Criteria
Indications
Evaluation for
Group A Streptococcal Pharyngitis
Criteria
Modified Centor (recommended)
Tonsil
lar exudate or erythema
Anterior cervical adenopathy
Cough
absent
Fever
present
Age
Age 3 to 14 years: +1 point
Age 15 to 45 years: 0 points
Age over 45 years: -1 points
Approach
Clinical Suspicion based on scoring above
Strep Score 4 to 5 (or Strep Score 2 if patient unreliable)
Treat with antibiotics
Strep Score 2 to 3: Perform rapid
Antigen
test
Antigen
test positive: Treat with antibiotics
Antigen
test negative:
Throat Culture
Strep Score 0 to 1
Provide
Pharyngitis Symptomatic Treatment
Criteria
Older, original criteria with derivation (1 point for each clinical finding)
Original Criteria (interpretation below based on these)
Tonsil
lar exudate
Tender, anterior cervical adenopathy
Cough
absent
Fever
present
Reference
Centor (1990) in Sox (1990) Common Diagnostic, p.247
Modifiers (Not included in interpretation below)
McIsaac Decision Rule modifier
Age younger than 15 years: +1 point
Age 15 to 45 years: 0 points
Age over 45 years: -1 points
McIsaac (2000) CMAJ 163:811-5 [PubMed]
Exposure to known
Pharyngitis
contact
Added with Walsh
Clinical Prediction Rule
s
McGinn (2003) Mayo Clin Proc 78:289-93 [PubMed]
Interpretation (Clinic and ER probability based on original criteria)
Based on original criteria above
Score 0:
Streptococcus
probability 1% (3% in ER)
Score 1:
Streptococcus
probability 4% (8% in ER)
Score 2:
Streptococcus
probability 9% (18% in ER)
Score 3:
Streptococcus
probability 21% (38% in ER)
Score 4:
Streptococcus
probability 43% (63% in ER)
References
Centor (1990) in Sox (1990) Common Diagnostic, p.247
Sloane (1998) Family Medicine, p. 629
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