Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis
Published Date:Jun 11 2012
Source:Arch Intern Med. 172(11):847-852.
Area Under Curve
Practice Guidelines As Topic
Predictive Value Of Tests
Primary Health Care
Pubmed Central ID:PMC3627733
Funding:G08 LM009778/LM/NLM NIH HHS/United States
G08LM009778/LM/NLM NIH HHS/United States
K01HK000055/HK/PHITPO CDC HHS/United States
P01HK000088/HK/PHITPO CDC HHS/United States
R01 LM007677/LM/NLM NIH HHS/United States
R01LM007677/LM/NLM NIH HHS/United States
The Centor and McIsaac scores guide testing and treatment for group A streptococcal (GAS) pharyngitis in patients presenting with a sore throat, but were derived on relatively small samples. We perform a national-scale validation of the prediction models on a large, geographically diverse population.
Analysis of data collected from 206,870 patients 3 years and above who presented with a painful throat to a United States national retail health chain, from September 2006-December 2008. Main outcome meaures were the proportions of patients testing positive for GAS pharyngitis according to Centor and McIsaac scores (both scales 0-4).
For patients 15 years and older, 23% (95% confidence interval (CI) 22%-23%) tested GAS positive including 7% (7-8%) of those with a Centor score of 0, 12% (11-12%) with 1, 21% (21-22%) with 2, 38% (38-39%) with 3, and 57% (56-58%) with 4. For patients 3 years and older, 27% (95% CI 27-27%) tested GAS positive with 8% (8-9%) of those testing positive with McIsaac score 0, 14% (13-14%) with 1, 23% (23-23%) with 2, 37% (37-37%) with 3, and 55% (55-56%) with 4. 95% CI’s overlapped between the MinuteClinic derived probabilities and the prior reports.
Our study validates the Centor and McIsaac scores and more precisely classifies risk of GAS infection among patients presenting with a painful throat to a retail health chain.
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