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Performance of a Predictive Model for Streptococcal Pharyngitis in Children
Magdy W. Attia, MD;
Theoklis Zaoutis, MD;
Joel D. Klein, MD;
Frederick A. Meier, MD
Arch Pediatr Adolesc Med. 2001;155:687-691.
Context Group A ß-hemolytic streptococcus (GABHS) pharyngitis is a common
childhood illness. The clinical diagnosis is difficult to determine and laboratory
tests have limitations; hence, the condition is generally overdiagnosed and
overtreated. Several clinical pediatric-specific predictive models have been
published but none have been prospectively studied.
Objective To test the performance of a previously published predictive model for
GABHS pharyngitis in children in different clinical settings and during different
seasons.
Design Prospective cohort study.
Settings Pediatric emergency department and 2 pediatric outpatient clinics.
Patients Children aged between 1 and 18 years with pharyngitis on initial examination
at study sites between April 1, 1999, and March 31, 2000.
Interventions Recording of clinical features during initial evaluation using a standardized
form and recovery of GABHS from patients' throats using reference standard
methods.
Main Outcome Measures Posttest probability for GABHS positive throat culture associated with
the model's positive predictors (moderate to severe tonsillar swelling, cervical
lymphadenopathy [moderate to severe tenderness and enlargement of cervical
lymph nodes], scarletiniform rash, and the absence of coryza) and the models'
negative predictors (absence of the above signs and the presence of coryza).
Results Of 587 patients analyzed, 218 (37%) had a positive throat culture for
GABHS. Forty-nine percent were boys. Mean ± SD age was 6.7 ±
3.9 years. There was no difference between the subsets within the sample.
The posttest probability values for a positive throat culture associated with
positive and negative predictors of the model were 79% and 12%, respectively.
Conclusions A pediatric predictive model for GABHS pharyngitis performed better
than physicians' subjective estimates for a positive throat culture and was
comparable with a rapid antigen detection test. The model performed consistently
well in different populations and across seasons. It can be useful if reliable
microbiological testing and/or follow-up are not attainable.
From the Departments of Pediatrics (Drs Attia, Zaoutis, Klein, and
Meier) and Pathology (Dr Meier), Alfred I. duPont Hospital for Children, Wilmington,
Del; and Thomas Jefferson Medical College, Philadelphia, Pa. Dr Zaoutis is
currently affiliated with the Children's Hospital of Philadelphia, Philadelphia,
Pa.
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