A STREPTOCOCCAL SCORE CARD REVISITED

Objective: To evaluate the utility of a simple scoring system as a pre dictor of obtaining a positive throat culture for group A streptococci (GAS), Design: Prospective descriptive study. Scores were assigned pr ior to the availability of the results of throat cultures. Setting: Em ergency department and walk-in clinic of the Children's Hospital of Pi ttsburgh. Patients: Patients were 365 children between the ages of two and 16 years with acute onset of sore throat and a history of or docu mentation of fever within the preceding 24 hours. Interventions: A str eptococcal score was assigned on the basis of a 6-point schema in whic h the features were 1) age; 2) season; 3) temperature of at least 38.3 degrees C; 4) adenopathy; 5) pharyngeal erythema, edema, or exudate; and 6) no symptoms of a viral upper respiratory infection (conjunctivi tis, rhinorrhea, or cough). A throat culture was performed for the iso lation of GAS, Main outcome measure: Positive predictive value of the streptococcal score in identifying children with a positive throat cul ture for GAS. Results: A score of 5 or 6 predicted a positive culture for GAS in 59 and 75% of children, respectively. In patients with evid ence of acute pharyngitis, the combination of age between five and 15 years, fever and absence of upper respiratory symptoms predicted a pos itive culture for GAS in 72% of patients. Conclusions: The score can b e used to predict the likelihood that a throat culture will be positiv e for GAS.