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Comparative Study
. 2007 Jul;39(7):361-5.
doi: 10.1157/13107724.

[Is streptococcal pharyngitis diagnosis possible?]

[Article in Spanish]
Jaime Marín Cañada  1 , Ana Cubillo Serna, Nieves Gómez-Escalonilla Cruz, Jesús Garzón de la Iglesia, Luis Benito Ortiz, M Nieves Reyes Fernández
Affiliations
Comparative Study

[Is streptococcal pharyngitis diagnosis possible?]

[Article in Spanish]
Jaime Marín Cañada et al. Aten Primaria. 2007 Jul.

Abstract
in English, Spanish

Objective: To determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab).

Design: Descriptive study.

Setting: San Fernando 2 Health Centre, Madrid (outer urban area), Spain.

Participants: On hundred forty patients over 14 years old who had a "sore throat" as main symptom and attended clinic between 14 February and 12 May, 2005.

Main measurements: Sensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method.

Results: Thirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology.

Conclusions: The high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty. What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic).

Objetivo: Determinar la validez de la puntuación de Centor (adenopatías cervicales, exudado amigdalar, fiebre y ausencia de síntomas catarrales) para filiar la faringoamigdalitis de origen estreptocócico.

Diseño: Estudio descriptivo.

Emplazamiento: Centro de Salud San Fernando 2 (zona periurbana de Madrid).

Participantes: Se incluyó a 140 pacientes mayores de 14 años que acudieron a la consulta entre el 14 de febrero y el 12 de mayo de 2005 con «dolor de garganta» como principal síntoma.

Mediciones principales: Se determinaron la sensibilidad (S), la especificidad (E), los valores predictivos postivo y negativo (VPP y VPN) y los cocientes de probabilidad de la puntuación de Centor; se utilizó el frotis faríngeo como método de referencia.

Resultados: En total, 34 pacientes presentaron frotis positivo (24,3%; intervalo de confianza [IC] del 95%, 17,6-32,4%). El hallazgo de los 4 criterios de Centor presentaba un VPP del 48,1% (IC del 95%, 30,7-66,0%) y un VPN del 81,4% (IC del 95%, 73,3-87,5%), aunque sólo la fiebre (odds ratio [OR] = 3,64; IC del 95%, 1,40- 9,49) y el exudado amigdalar (OR = 6,18; IC del 95%, 2,08-18,35) muestran asociación con la etiología estreptocócica.

Conclusiones: El sistema de puntuación clínica alcanza un alto VPN y una especificidad que permiten diagnosticar con bastante certeza las faringoamigdalitis no estreptocócicas. Sin embargo, su VPP es bajo: una puntuación alta (3 o 4 criterios) no asegura que sea una faringoamigdalitis estreptocócica. Queda por resolver qué actitud se debe adoptar ante estos pacientes con sospecha de faringitis estreptocócica: test microbiológico, antibioterapia inmediata o antibioterapia diferida.

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