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Nine-Factor Streptococcal Pharyngitis Scorecard

Purpose: To evaluate a patient for streptococcal pharyngitis using the 9-item scorecard of Breese.

Description

Breese developed a scorecard with 9 items to aid in the diagnosis of Streptococcal pharyngitis. The author was from the University of Rochester in New York.


Parameters used for score:

(1) month of the year

(2) age

(3) WBC count

(4) body temperature

(5) sore throat

(6) cough

(7) headache

(8) abnormal pharynx

(9) abnormal cervical glands

 

Parameter

Finding

Points

month of the year

February, March, April

4

 

January, May, December

3

 

June, October, November

2

 

July, August, September

1

age in years

<= 2

1

 

3

2

 

4

3

 

5 – 10

4

 

11 – 14

3

 

>= 15

2

WBC count

unknown

3

 

<= 8,400 per µL

1

 

8,500 – 10,400 per µL

2

 

10,500 – 13,400 per µL

3

 

13,500 – 20,400 per µL

5

 

>= 20,500

6

body temperature

>= 100.5°F (fever present)

4

 

< 100.5°F

2

 

unknown

2

sore throat

yes

4

 

no

2

 

unknown

2

cough

yes

2

 

no

4

 

unknown

4

headache

yes

4

 

no

2

 

unknown

2

abnormal pharynx

yes

4

 

no

1

 

unknown

3

abnormal cervical lymph nodes (glands)

yes

4

 

no

2

 

unknown

3

 

score =

= SUM(points for all 9 factors)

 

Interpretation:

• minimum score: 14

• maximum score: 38

• Higher scores are associated with a higher probability of a positive Streptococcal Group A isolate.

 

Score

Streptococcal Pharyngitis is

Percent Positive Cultures (Breese Data)

18 – 25

unlikely

6.1%

26 – 29

maybe not

36.0%

30 – 31

maybe

56.4%

32 - 38

probably

84.4%

from Table 1, page 516

 

Performance:

• In Breese's study the streptococcal prevalence was 54% and the scorecard gave results comparable to the physician diagnosis. The physician was correct in 79.4% of cases while the scorecard was correct in 77.8%.

• Reed et al found the score to have a sensitivity of 26%, specificity of 94%, positive predictive value of 58% and a negative predictive value of 79% in a population of children with a streptococcal prevalence of 25%. Use of the score with a rapid antigen detection test did not improve the accuracy of either test significantly, and culture was felt to still be necessary.

 

Breese also describes a 13 factor scorecard which did not show greater accuracy than the 9 factor scorecard. This included the addition of:

(10) running nose

(11) diarrhea

(12) abnormal lungs

(13) abnormal ears.


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Specialty

Objective

ICD-10