I. Indications

II. Criteria: Modified Centor (recommended)

  1. Tonsillar exudate or erythema
  2. Anterior cervical adenopathy
  3. Cough absent
  4. Fever present
  5. Age
    1. Age 3 to 14 years: +1 point
    2. Age 15 to 45 years: 0 points
    3. Age over 45 years: -1 points

III. Approach: Clinical Suspicion based on scoring above

  1. Strep Score 4 to 5 (or Strep Score 2 if patient unreliable)
    1. Treat with antibiotics
  2. Strep Score 2 to 3: Perform rapid antigen test
    1. Antigen test positive: Treat with antibiotics
    2. Antigen test negative: Throat Culture
  3. Strep Score 0 to 1
    1. Provide Pharyngitis Symptomatic Treatment

IV. Criteria: Older, original criteria with derivation (1 point for each clinical finding)

  1. Original Criteria (interpretation below based on these)
    1. Tonsillar exudate
    2. Tender, anterior cervical adenopathy
    3. Cough absent
    4. Fever present
  2. Reference
    1. Centor (1990) in Sox (1990) Common Diagnostic, p.247
  3. Modifiers (Not included in interpretation below)
    1. McIsaac Decision Rule modifier
      1. Age younger than 15 years: +1 point
      2. Age 15 to 45 years: 0 points
      3. Age over 45 years: -1 points
      4. McIsaac (2000) CMAJ 163:811-5
    2. Exposure to known Pharyngitis contact
      1. Added with Walsh Clinical Prediction Rules
      2. McGinn (2003) Mayo Clin Proc 78:289-93

V. Interpretation (Clinic and ER probability based on original criteria)

  1. Based on original criteria above
  2. Score 0: Streptococcus probability 1% (3% in ER)
  3. Score 1: Streptococcus probability 4% (8% in ER)
  4. Score 2: Streptococcus probability 9% (18% in ER)
  5. Score 3: Streptococcus probability 21% (38% in ER)
  6. Score 4: Streptococcus probability 43% (63% in ER)

VI. References

  1. Centor (1990) in Sox (1990) Common Diagnostic, p.247
  2. Sloane (1998) Family Medicine, p. 629

Images: Related links to external sites (from Google)

Calculation (SoapNote.org)

Ontology: Streptococcal sore throat (C0036689)

Concepts Disease or Syndrome (T047)
ICD9 034.0
ICD10 J02.0
SnomedCT 186360000, 154302004, 186358002, 186361001, 43878008
English PHARYNGITIS, STREPTOCOCCAL, EPIDEMIC SORE THROAT, SEPTIC SORE THROAT, STREP THROAT, STREPTOCOCCAL PHARYNGITIS, Streptococcal sore throat NOS, streptococcal sore throat, streptococcal sore throat (diagnosis), strep throat, Streptococcal pharyngitis (disorder), Streptococcal angina (disorder), Strep Throat, Pharyngitis streptococcal, PHARYNGITIS STREPTOCOCCUS, Strep sore throat, Streptococcal sore throat NOS (disorder), Septic pharyngitis, strep throats, strept throat, streptococcal angina, streptococcus pharyngitis, Pharyngitis;streptococcal, Sore throat;streptococcal, septic sore throat, Streptococcal sore throat, Streptococcal pharyngitis, Septic sore throat, Streptococcal angina, Strep throat, Strept throat, Streptococcal sore throat (disorder), pharyngitis; septic, pharyngitis; streptoccocal, septic; pharyngitis, septic; sore throat, sore throat; septic, sore throat; streptoccocal, streptoccocal; pharyngitis, streptoccocal; sore throat, Septic sore throat due to streptococcal infection, streptococcal pharyngitis
Spanish faringitis estreptocócica, faringitis estreptocócica (trastorno), Infección estreptocócica de garganta, dolor de garganta séptico, dolor de garganta estreptocócico, dolor de garganta estreptocócico (trastorno), Streptococcal pharyngitis, Streptococcal angina, Streptococcal sore throat, angina estreptocócica, SAI (trastorno), angina estreptocócica, SAI, angina estreptocócica, dolor de garganta por estreptococo, SAI, Faringitis estreptocócica
Italian Faringite streptococcica, Angina streptococcica
Dutch streptokokkenangina, Streptokokken-angina, faryngitis; septisch, faryngitis; streptokokken, keelpijn; septisch, keelpijn; streptokokken, septisch; faryngitis, septisch; keelpijn, streptokokken; faryngitis, streptokokken; keelpijn, Streptokokkenfaryngitis, streptokokkenfaryngitis
French Angine streptococcique, Pharyngite streptococcique
German Halsschmerzen durch Streptokokken, Streptokokken-Pharyngitis, Pharyngitis durch Streptokokken
Japanese レンサ球菌性咽頭炎, レンサ球菌性咽喉痛, レンサキュウキンセイインコウツウ, レンサキュウキンセイイントウエン
Czech Streptokoková faryngitida, Streptokoková angína
Korean 사슬알균성 인두염
Hungarian streptococcus pharyngitis, streptococcus torokgyulladás, streptococcalis pharyngitis
Portuguese Faringite estreptocócica