The History Score for Streptococcal Pharyngitis of Clancy et al

Description

Clancy et al developed a history score for evaluating patients with sore throat. The history score plus prevalence of streptococcal pharyngitis in the community can be used to estimate the probability of streptococcal infection, which can aid the treatment decision prior to knowledge of culture results. The authors are from the Medical College of Virginia.

Patient population: adults in a primary care setting

Parameters for history score:

(1) fever history

(2) difficulty in swallowing

(3) cough

Parameter	Finding	Points
fever history	absent	0
	mild	1
	moderate	2
	severe	3
difficulty in swallowing	absent	0
	mild	1
	moderate	2
	severe	3
cough	absent	0
	mild	1
	moderate	2
	severe	3

history score =

= (points for fever history) + (points for difficulty in swallowing) – (points for cough)

Interpretation:

• minimum score: -3

• maximum score: +6

• The higher the score, the more likely the presence of group A beta hemolytic streptococci.

• The higher the prevalence of the streptococcal pharyngitis in the community, the greater the significance for a given history score.

	Probability of Streptococcal Pharyngitis
History Score	Low (10%) Prevalence of Group A beta Hemolytic Streptococci	High (34%) Prevalence of Group A beta Hemolytic Streptococci
-3	0.01	0.03
-2	0.01	0.05
-1	0.02	0.08
0	0.03	0.12
+1	0.05	0.19
+2	0.07	0.27
+3	0.11	0.37
+4	0.17	0.48
+5	0.24	0.60
+6	0.34	0.70

Performance:

• 85% sensitive and 42% specific

• area under the ROC curve 0.70 to 0.74

• No prospective validation performed.

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Description

Specialty

ICD-10