SHOULD NURSES IN ISRAELI PRIMARY-CARE CLINICS BE EXPECTED TO MANAGE STREPTOCOCCAL THROAT INFECTIONS

Introduction: Legal regulations in Israel allow nurses to perform only limited clinical procedures. Objective: To determine the probability of streptococcal infection in adults with sore throat, as assessed cli nically by standard nursing procedures. Design: Using throat culture a s the standard, the contribution of various clinical findings (fever, exudate, erythrocyte sedimentation rate (ESR), white blood count) to t he determination of the diagnosis of streptococcal infection was asses sed, using logistic regression analysis. Setting: Israeli general prac tice. Patients: 100 consecutive adult patients presenting with a red, sore throat. Results: Six patients showed the full clinical picture of exudate, increased ESR and leukocytosis, with an 82% probability of s treptococcal infection. Forty-nine patients showed none of these three findings, and only one of them (among the three patients with rhiniti s) had a positive throat swab. Forty-five patients showed an intermedi ate clinical picture which did not provide a reliable basis for the di agnosis or exclusion of streptococcal infection. Fever alone did not s ignificantly (P < 0.05) predict streptococcal infection. Conclusions: Nurses may safely discharge adult patients with a red, sore throat wit hout antibiotic treatment only if they have no additional signs or sym ptoms. The few patients with all the clinical findings may be treated with antibiotics without a throat swab. All other patients should be r eferred for examination by a doctor.