_id

683a15f1c782e11e38d1b0aa

id

104

title

Centor Score (Modified/McIsaac) for Strep Pharyngitis

full_title

Centor Score (Modified/McIsaac) for Strep Pharyngitis

short_title

Centor Score (Modified/McIsaac)

med_description

Estimates probability that pharyngitis is streptococcal, and suggests management course.

short_description

Strep throat diagnosis and treatment.

slug

centor-score-modified-mcisaac-strep-pharyngitis

description

The Centor Score (Modified) for Strep Pharyngitis Estimates probability that pharyngitis is streptococcal, and suggests management course.

keywords

Centor Score (Modified) for Strep Pharyngitis, dx strep, dx strep, pharyngitis calc, pharyngitis calculator, pharyngitis score, strep throat calc, strep throat score, streptococcal score, streptococcal calc, r/o strep, rule out strep, centor score, centor strep, centor calc, centor score strep

complaint

[ "Cough", "Fever", "Sore Throat" ]

formula

Addition of the selected points:

evidence

The original study by Centor et al was done in 1981 to develop criteria to diagnose GAS infection in adult patients presenting to the emergency department with sore throat (Centor 1981). The original model designated four criteria: tonsillar exudates, swollen tender anterior cervical nodes, absence of a cough, and history of fever. Patients exhibiting all four variables had a 56% probability of a Group A beta strep positive culture; three variables, 32%; two variables, 15%; one variable, 6.5%; and zero variables, 2.5%.

The Centor Score was later modified to include age (McIsaac 1998) and validated (McIsaac 2004) for use in both children and adults presenting with sore throat. McIsaac et al (1998) determined that using the Centor Score would reduce the number of unnecessary initial antibiotic prescriptions by 48%, without an increase in throat culture use.

The Centor Score and its modifications were derived in relatively small samples (n=286 and n=521, respectively). In order to more precisely classify the risk of GAS infection, Fine et al (2012) performed a national-scale validation of the score on a geographically diverse population of over 140,000 patients presenting in a clinical setting. The study was carried out over the course of more than a year, mitigating any impact of seasonality of GAS incidence on the results. This analysis provided more precise interpretations of risk for each category of the Centor Score; these still fell within the 95% confidence interval of Centor's original study with a much smaller sample size.

In their comparison of the Centor Score with other identification and treatment strategies, McIsaac et al (2004) found that use of the score resulted in fewer overall tests (cultures and rapid tests) per person but more throat cultures (96.1% of adults) than other strategies. As a result, the Centor Score represented a compromise, requiring the least diagnostic testing, providing 100% sensitivity and greater than 90% specificity in both children and adults, and producing significant reductions in unnecessary use of antibiotics, compared to other strategies.

Harris et al (2016) encourage the use of the Centor Score primarily to identify patients with a low probability of Group A streptococcal pharyngitis who do not warrant further testing, citing the criteria's low positive predictive value.

measurements

[]

information

Interpretation:

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/6763125", "text": "Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239-46." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/9475915", "text": "McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998 Jan 13;158(1):75-83. PubMed PMID: 9475915; PubMed Central PMCID: PMC1228750." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21646249", "text": "Mitchell MS, Sorrentino A, Centor RM. Adolescent pharyngitis: a review of bacterial causes. Clin Pediatr (Phila). 2011;50(12):1091-5." }, { "href": "https://academic.oup.com/cid/article/55/10/e86/321183", "text": " Shulman ST, et. al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):1279-82." }, { "href": "https://annals.org/article.aspx?articleid=2481815", "text": "Harris AM, Hicks LA, Qaseem A, for the High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016 Jan 19. doi: 10.7326/M15-1840." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/27386721?dopt=Abstract", "text": "Kalra MG, Higgins KE, Perez ED. Common Questions About Streptococcal Pharyngitis. Am Fam Physician. 2016;94(1):24-31." } ], "Outcomes": [], "Validation": [ { "href": "https://jama.jamanetwork.com/article.aspx?articleid=198485", "text": "McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical Validation of Guidelines for the Management of Pharyngitis in Children and Adults. JAMA.2004;291(13):1587-1595. doi:10.1001/jama.291.13.1587." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627733/", "text": "Fine AM, Nizet V, Mandl KD. Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis. Archives of internal medicine 2012;172(11):847-852. doi:10.1001/archinternmed.2012.950." } ], "Validations": [] }

pearls

• The Centor Score correlates directly with risk of positive throat culture for GAS (Group A Streptococcus).
• New 2012 guidelines from the IDSA (Infectious Disease Society of America) no longer recommend empiric treatment for patients alone; they recommend testing patients that are at higher risk for strep pharyngitis, but not giving antibiotics until a rapid test is positive or a throat culture is positive.
• The modified criteria by McIsaac et al include an age component, along with tonsillar swelling, as part of the rule. GAS is incredibly rare in patients under 3 and less common in older adults, so this can help clinicians risk stratify patients.
• Most cases of pharyngitis are viral in origin, and with the rare incidence of rheumatic fever, along with the questionable benefits of early antibiotics to prevent sequelae like peritonsillar abscess, antibiotics are prescribed much less often. Steroids (like dexamethasone) and NSAIDS often provide similar pain relief and resolution of symptoms to antibiotics.

usecase

Children with pharyngitis, primarily; the risk of GAS decreases significantly with age into adulthood.

reasons

Most pharyngitis is viral and does not respond to antibiotic treatment. The Centor Score attempts to predict which patients will have culture-confirmed streptococcal infections of their pharynx to help determine which patients to test in the first place. The newer FeverPAIN Score is similar, but the Centor Score distinguishes between adolescents/young adults and pre-adolescents—important because strep carrier rates are higher in preadolescents than adolescents/young adults, and older patients are more likely to have severe symptoms and develop suppurative complications (Mitchell 2011).

next_advice

Steroids and NSAIDS improve symptoms; antibiotics are often indicated in streptococcal pharyngitis, but do not prevent its suppurative complications, like peritonsillar abscess.

next_actions

• Carefully consider patients with symptom duration longer than 3 days, even though the Centor Score does not apply.
• While symptoms are not compatible with a diagnosis of acute pharyngitis, these patients require evaluation for suppurative complications (peritonsillar abscess or Lemierre syndrome), or viral infections in adult patients (infectious mononucleosis or acute HIV) (Centor 2017).

next_management

diseases

[ "Acute Pain", "Coronavirus", "COVID-19", "Pharyngitis", "Strep Pharyngitis" ]

input_schema

[ { "conditionality": "", "default": null, "label_en": "<p>Age</p>", "mdcalc_info_concept": null, "name": "age_range", "option_fhir_rules": null, "optional": false, "options": [ { "label": "3-14 years", "value": 1 }, { "label": "15-44 years", "value": 0 }, { "label": "≥45 years", "value": -1 } ], "show_points": true, "tips_en": "Group A streptococcus (GAS) rare under 3", "type": "radio" }, { "conditionality": "", "default": null, "label_en": "<p>Exudate or swelling on tonsils</p>", "md_calc_info_concept": null, "name": "exudate_swelling", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "<p>Tender/swollen anterior cervical lymph nodes</p>", "md_calc_info_concept": null, "name": "lymph_nodes", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "<p>Temp &gt;38&deg;C (100.4&deg;F)</p>", "md_calc_info_concept": null, "name": "fever", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "<p>Cough</p>", "mdcalc_info_concept": null, "name": "cough", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Cough present", "value": 0 }, { "label": "Cough absent", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" } ]

instructions

Use only in patients with recent onset (≤3 days) acute pharyngitis.

published

2022-04-21T20:28:52.519Z

purpose

[ "Diagnosis", "Rule Out", "Treatment" ]

search_terms

[ "strep", "sore throat", "centaur", "centor", "covid", "covid19", "covid-19", "covid 19", "coronavirus" ]

seo

{ "keywords_en": "Centor Score (Modified) for Strep Pharyngitis, dx strep, dx strep, pharyngitis calc, pharyngitis calculator, pharyngitis score, strep throat calc, strep throat score, streptococcal score, streptococcal calc, r/o strep, rule out strep, centor score, centor strep, centor calc, centor score strep", "meta_description_en": "The Centor Score (Modified) for Strep Pharyngitis Estimates probability that pharyngitis is streptococcal, and suggests management course." }

specialty

[ "Emergency Medicine", "Family Practice", "Hospitalist Medicine", "Infectious Disease", "Internal Medicine", "Oral and Maxillofacial Surgery", "Otolaryngology", "Pediatrics" ]

departments

[ "HEENT" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 2654, "short_title_en": "qSOFA", "slug": "qsofa-quick-sofa-score-sepsis" }, { "calcId": 4050, "short_title_en": "DRIP Score", "slug": "drug-resistance-pneumonia-drip-score" }, { "calcId": 797, "short_title_en": "Light's Criteria", "slug": "lights-criteria-exudative-effusions" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "otolaryngology" ]

cleaned_use

[ "Children with pharyngitis, primarily; the risk of GAS decreases significantly with age into adulthood." ]

pub

true