Does this patient have strep throat?

Mark H. Ebell, Mindy A. Smith, Henry C. Barry, Kathy Ives, Mark Carey

Research output: Contribution to journalArticle

212 Citations (Scopus)

Abstract

Context: Sore throat is a common complaint, and identifying patients with group A β-hemolytic streptococcal pharyngitis (strep throat) is an important task for clinicians. Previous reviews have not systematically reviewed and synthesized the evidence. Objective: To review the precision and accuracy of the clinical examination in diagnosing strep throat. Data Source: MEDLINE search for articles about diagnosis of strep throat using history-taking and physical examination. Study Selection: Large blinded, prospective studies (having ≥300 patients with sore throat) reporting history and physical examination data and using throat culture as the reference standard were included. Of 917 articles identified by the search, 9 met all inclusion criteria. Data Extraction: Pairs of authors independently reviewed each article and used consensus to resolve discrepancies. Data Synthesis: The most useful findings for evaluating the likelihood of strep throat are presence of tonsillar exudate, pharyngeal exudate, or exposure to strep throat infection in the previous 2 weeks (positive likelihood ratios, 3.4, 2.1, and 1.9, respectively) and the absence of tender anterior cervical nodes, tonsillar enlargement, or exudate (negative likelihood ratios, 0.60, 0.63, and 0.74, respectively). No individual element of historytaking or physical examination is accurate enough by itself to rule in or rule out strep throat. Three validated clinical prediction rules are described for adult and pediatric populations. Conclusions: While no single element of history-taking or physical examination is sufficiently accurate to exclude or diagnose strep throat, a well-validated clinical prediction rule can be useful and can help physicians make more informed use of rapid antigen tests and throat cultures.

Original languageEnglish (US)
Pages (from-to)2912-2918
Number of pages7
JournalJournal of the American Medical Association
Volume284
Issue number22
DOIs
StatePublished - Dec 13 2000
Externally publishedYes

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Pharynx
Physical Examination
Pharyngitis
Exudates and Transudates
Decision Support Techniques
History
Information Storage and Retrieval
MEDLINE
Prospective Studies
Pediatrics
Physicians
Antigens
Infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ebell, M. H., Smith, M. A., Barry, H. C., Ives, K., & Carey, M. (2000). Does this patient have strep throat? Journal of the American Medical Association, 284(22), 2912-2918. https://doi.org/10.1001/jama.284.22.2912

Does this patient have strep throat? / Ebell, Mark H.; Smith, Mindy A.; Barry, Henry C.; Ives, Kathy; Carey, Mark.

In: Journal of the American Medical Association, Vol. 284, No. 22, 13.12.2000, p. 2912-2918.

Research output: Contribution to journalArticle

Ebell, MH, Smith, MA, Barry, HC, Ives, K & Carey, M 2000, 'Does this patient have strep throat?', Journal of the American Medical Association, vol. 284, no. 22, pp. 2912-2918. https://doi.org/10.1001/jama.284.22.2912
Ebell MH, Smith MA, Barry HC, Ives K, Carey M. Does this patient have strep throat? Journal of the American Medical Association. 2000 Dec 13;284(22):2912-2918. https://doi.org/10.1001/jama.284.22.2912
Ebell, Mark H. ; Smith, Mindy A. ; Barry, Henry C. ; Ives, Kathy ; Carey, Mark. / Does this patient have strep throat?. In: Journal of the American Medical Association. 2000 ; Vol. 284, No. 22. pp. 2912-2918.
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