_id

683a160ac782e11e38d1b158

id

3316

title

FeverPAIN Score for Strep Pharyngitis

full_title

FeverPAIN Score for Strep Pharyngitis

short_title

FeverPAIN Score

med_description

Predicts likelihood of strep throat.

short_description

Predicts likelihood of strep throat.

slug

feverpain-score-strep-pharyngitis

description

The FeverPAIN for Streptococcal Pharyngitis calculates likelihood of strep throat and need for antibiotic prescription.

keywords

feverpain, fever pain strep, fever pain strep throat, fever pain score, feverpain score, strep throat score, feverpain southampton, exudates feverpain, r/o strep, erythema feverpain, exudate on throat score, pus in through score, swollen glands score, fever with strep score, cough/cold symptoms vs strep, viral vs bacterial strep, r/o strep, abx treatment strep, antibiotic treatment strep, abx tx strep, abx strep calc

complaint

[ "Sore Throat" ]

formula

evidence

The FeverPAIN Score was derived from a study of 1,760 patients aged 3 years and up. The objective of the authors was to design a clinical tool that was able to predict streptococcal infection, thereby reducing the need for both rapid antigen detection tests and potentially unnecessary antibiotics. In the study, three groups were compared: a control group in which patients received a delayed antibiotic prescription (to fill in 3-5 days if no symptom relief), a clinical score group, and a rapid antigen detection test (RAT) group. 

In the clinical score group, antibiotics were not offered to those with scores of 0/1, delayed antibiotics were offered for those with scores of 2/3 and immediate antibiotics were offered to those with scores of 4 or higher. Diagnostic studies in this group showed that 63% of those with scores of 4 or higher had a streptococcal infection. Lastly, in the RAT group, those with low scores of 0/1 were not offered a RAT, those with a score of 2 were offered a delayed prescription, and those with a score of 3 or more underwent a RAT on premises. Of that group, 55% had a streptococcal infection.

The authors concluded that the use of RAT according to a clinical score provided no clear advantage over a clinical score alone. Additionally, the authors looked at symptom relief and found that the use of a clinical score was shown to improve symptoms and reduce antibiotic usage in affected patients.

A randomized controlled trial looking at the FeverPAIN Score was done by Little et al in 2014. The authors found that use of the FeverPAIN score resulted in a reduction in symptom severity as well as a reduction in antibiotic usage as compared to a delayed treatment group. Moderate or worse symptom severity was also reduced as compared to a RAT group, however antibiotic usage was similar between the FeverPAIN group and the RAT group. The authors concluded that using a clinical score to target antibiotic use will both improve symptoms and reduce overall antibiotic use.

measurements

[]

information

Score interpretation:

• A score of 0-1 is associated with 13-18% isolation of streptococcus (close to background carriage rates).
• No antibiotics recommended.
• A score of 2 is associated with 30-35% isolation of streptococcus.
• Delayed antibiotic may be appropriate.
• A score of 3 is associated with 39-48% isolation of streptococcus.
• Delayed antibiotic may be appropriate.
• A score of 4 or more is associated with 62-65% isolation of streptococcus.
• Consider antibiotics if symptoms are severe or a short delayed prescribing strategy may be appropriate (48 hours).

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23211183", "text": "Little P, et al. Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study. Br J Gen Pract. 2012 Nov;62(604):e787-94." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805475/#!po=87.5000", "text": "Little P, Hobbs FDR, Moore M, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ : British Medical Journal. 2013;347:f5806. doi:10.1136/bmj.f5806." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/books/NBK261552/", "text": "Little P, Moore M, Hobbs FDR, et al. Chapter 3: Two diagnostic cohorts to identify clinical variables associated with Lancefield group A beta-haemolytic streptococci and Lancefield non-group A streptococcal throat infections. In: PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study." }, { "href": "https://www.ncbi.nlm.nih.gov/books/NBK261552/", "text": "Little P, Moore M, Hobbs FDR, et al. Chapter 3: Two diagnostic cohorts to identify clinical variables associated with Lancefield group A beta-haemolytic streptococci and Lancefield non-group A streptococcal throat infections. In: PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/24163209", "text": "Little P, et al. PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A β-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat. BMJ Open. 2013 Oct 25;3(10):e003943." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/24467988", "text": "Little P, PRISM investigators, et. al. PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study. Health Technol Assess. 2014 Jan;18(6):vii-xxv, 1-101. doi: 10.3310/hta18060." } ], "Validations": [] }

pearls

• The FeverPAIN Score for Strep Pharyngitis was developed to try and help assess which patients with pharyngitis have streptococcal infections.

• Developed in the setting of rapid antigen detection tests for multiple streptococcal strains (Group A, C, G).

• While it should be further validated, it appeared to have better utility than the Centor Criteria at lower levels to detect patients who could forgo antibiotic treatment (Little 2014).

• Caution should be advised in using the FeverPAIN Score to determine need for treatment in patients that have worsening symptoms beyond 3 days. Beyond this point, the clinician must consider the possibility of a more serious or invasive infection.

• Should not be used in children <3 years old, as they are more likely to have viral infections and/or atypical presentations of streptococcal infection.

usecase

Patients with pharyngitis in primary care settings.

reasons

Identifying the minority of pharyngitis patients with streptococcal infection can help providers reduce inappropriate antibiotic use in pharyngitis. The authors that derived the FeverPAIN Score performed an implementation study suggesting it can safely reduce antibiotic use by 30% (Little 2014).

next_advice

A low FeverPAIN Score suggests streptococcal infection is unlikely.

next_actions

The FeverPAIN Score requires close examination of the pharynx and precise history taking.

next_management

diseases

[ "Pharyngitis", "Strep Pharyngitis" ]

input_schema

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instructions

published

2022-04-21T20:29:15.495Z

purpose

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

search_terms

[ "feverpain", "fever", "pain", "strep throat", "streptococcal", "pharyngitis", "sore throat", "exudates", "erythema" ]

seo

{ "keywords_en": "feverpain, fever pain strep, fever pain strep throat, fever pain score, feverpain score, strep throat score, feverpain southampton, exudates feverpain, r/o strep, erythema feverpain, exudate on throat score, pus in through score, swollen glands score, fever with strep score, cough/cold symptoms vs strep, viral vs bacterial strep, r/o strep, abx treatment strep, antibiotic treatment strep, abx tx strep, abx strep calc", "meta_description_en": "The FeverPAIN for Streptococcal Pharyngitis calculates likelihood of strep throat and need for antibiotic prescription." }

specialty

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

departments

[ "HEENT" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 104, "short_title_en": "Centor Score (Modified/McIsaac)", "slug": "centor-score-modified-mcisaac-strep-pharyngitis" }, { "calcId": 4027, "short_title_en": "Jones Criteria for ARF", "slug": "jones-criteria-acute-rheumatic-fever-diagnosis" }, { "calcId": 4049, "short_title_en": "Rochester Criteria", "slug": "rochester-criteria-febrile-infants" } ]

ismed

true

section

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

cleaned_departments

[ "otolaryngology" ]

cleaned_use

[ "Patients with pharyngitis in primary care settings." ]

pub

false