Pragmatic Scoring System for Pharyngitis in Low-Resource Settings

Abstract

OBJECTIVE: Our objective was to develop an easy, safe, pragmatic, clinical scoring system that would allow decreases in unnecessary treatment with antimicrobial agents in low-resource settings. METHODS: Children with pharyngitis were enrolled prospectively from 2 public hospitals and 1 medical unit in Brasilia, Brazil, over 17 months. Attending clinicians completed a questionnaire and a previously published scoring system for pharyngitis before performing throat swabs and group A streptococcus (GAS) rapid antigen-detection tests. Data from this study were added to those collected in 2004, to assess the performance of each item of the scoring system. The performance of the new clinical decision rule was determined with a receiver operating characteristic curve. The final outcome of the model was assessed on the basis of sensitivity, specificity, and positive likelihood ratio for non-GAS infections with the clinical approach, compared with throat culture or rapid antigen-detection test results. RESULTS: A total of 576 children were included, among whom 400 had non-GAS pharyngitis. The use of our new clinical decision rule would allow for 35% to 55% antibiotic reduction, with 88% specificity. CONCLUSIONS: This clinical decision rule could reduce unnecessary antibiotic treatment significantly in low-resource settings.