DO GASTROINTESTINAL SYMPTOMS ACCOMPANYING SORE THROAT PREDICT STREPTOCOCCAL PHARYNGITIS - AN UPRNET STUDY

BACKGROUND. The purpose of this study was to determine whether gastroi ntestinal (GI) symptoms are more common in streptococcal than nonstrep tococcal pharyngitis, and, if so, whether these symptoms are useful di agnostic predictors. METHODS. Patients aged 4 and older presenting con secutively to one of three family practice clinics and one emergency d epartment with the chief complaint of sore throat were invited to part icipate in the study. A nurse administered a brief symptom checklist; after documenting clinical signs, the clinician assessed and treated t he patient. All patients were screened for group A streptococcus using the Abbott Test Pack Plus. Patients were enrolled from January 1996 t hrough March 1996. Significant associations of signs and symptoms with streptococcal pharyngitis were determined by chi square, likelihood r atios were calculated, and logistic regression was used to compare dia gnostic prediction models with and without GI symptoms. RESULTS. Six h undred fifty-seven consecutive patients with the presenting complaint of sore throat were enrolled in the study. The mean age of the patient s enrolled was 19 years; the median age was 14. Thirty-two percent of the children (ages 4 to 18), 23% of the adults (ages 19 to 74), and 29 % of all patients had streptococcal pharyngitis. Symptom frequencies f or streptococcal and nonstreptococcal pharyngitis, respectively, were: nausea (39% vs 31%, P = .14); vomiting (14% vs 7%, P = .004); abdomin al pain (27% vs 26%, P = .621); and any GI symptom (47% vs 41%, P = .4 5). When included in a predictive model with other significant predict ors of streptococcal pharyngitis including age, palatal petechiae, abs ence of cough, and anterior cervical adenopathy, the addition of nause a or vomiting added slight predictive power to the models, but abdomin al pain and ''any GI symptom'' did not. CONCLUSIONS. Nausea and vomiti ng are somewhat more common in streptococcal than in nonstreptococcal pharyngitis, but appear to have limited usefulness as clinical predict ors of streptococcal pharyngitis.