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Strep ScoreAka: Walsh Pharyngitis Criteria, McIsaac Decision Rule

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  1. Indications
    1. Evaluation for Group A Streptococcal Pharyngitis
  2. Criteria (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. 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
      2. Exposure to known Pharyngitis contact
        1. Added with Walsh Clinical Prediction Rules
        2. McGinn (2003) Mayo Clin Proc 78:289
  3. Interpretation (Clinic and ER probability)
    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)
  4. Approach: Clinical Suspicion based on Strep Score
    1. Strep Score 4 (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
  5. References
    1. Centor (1990) in Sox (1990) Common Diagnostic, p.247
    2. Sloane (1998) Family Medicine, p. 629

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