Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds

Abstract

Background: Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis.

Aim: To compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with pharyngitis.

Design and setting: A meta-analysis of diagnostic test accuracy studies conducted in primary care was performed using a novel model that incorporates data at multiple thresholds.

Method: MEDLINE, EMBASE, and PsycINFO were searched for studies published between January 1980 and February 2019. Included studies were: cross-sectional; recruited patients with sore throats from primary care; used the Centor or McIsaac score; had GABHS infection as the target diagnosis; used throat swab culture as the reference standard; and reported 2 × 2 tables across multiple thresholds. Selection and data extraction were conducted by two independent reviewers. QUADAS-2 was used to assess study quality. Summary receiver operating characteristic (SROC) curves were synthesised. Calibration curves were used to assess the transferability of results into practice.

Results: Ten studies using the Centor score and eight using the McIsaac score were included. The prevalence of GABHS ranged between 4% and 44%. The areas under the SROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The P-value for the difference (0.0164) was 0.419, suggesting the SROC curves for the tests are equivalent. Both scores demonstrated poor calibration.

Conclusion: Both Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection.

Keywords: Centor score; McIsaac score; diagnosis; meta-analysis; pharyngitis; primary health care.

Figure 1.

Flow chart of studies selected.

Figure 2.

Centor score: ROC curves for each of the included studies. Each line corresponds to a single study and each dot corresponds to the (sensitivity, 1 − specificity) pair at a particular threshold for that study. ROC = receiver operating characteristic.

Figure 3.

McIsaac score: ROC curves for each of the included studies. Each line corresponds to a single study and each triangle corresponds to the (sensitivity, 1 − specificity) pair at a particular threshold for that study. ROC = receiver operating characteristic.

Figure 4.

SROC curves for the McIsaac and Centor scores. SROC = summary receiver operating characteristic.

Figure 5.

Calibration plots (corrected for optimism) for the Centor and McIsaac scores for a positive test result when the prevalence of GABHS is assumed to be known. GABHS = group A beta-haemolytic streptococcus. PPV = positive predictive value.