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PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A ?-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat

PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A ?-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat
PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A ?-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat
Objective: To assess the association between features of acute sore throat and the growth of streptococci from culturing a throat swab.

Design: Diagnostic cohort.

Setting: UK general practices.

Participants: Patients aged 5 or over presenting with an acute sore throat. Patients were recruited for a second cohort (cohort 2, n=517) consecutively after the first (cohort 1, n=606) from similar practices.

Main outcome: Predictors of the presence of Lancefield A/C/G streptococci.

Results: The clinical score developed from cohort 1 had poor discrimination in cohort 2 (bootstrapped estimate of area under the receiver operator characteristic (ROC) curve (0.65), due to the poor validity of the individual items in the second data set. Variables significant in multivariate analysis in both cohorts were rapid attendance (prior duration 3?days or less; multivariate adjusted OR 1.92 cohort, 1.67 cohort 2); fever in the last 24?h (1.69, 2.40); and doctor assessment of severity (severely inflamed pharynx/tonsils (2.28, 2.29)). The absence of coryza or cough and purulent tonsils were significant in univariate analysis in both cohorts and in multivariate analysis in one cohort. A five-item score based on Fever, Purulence, Attend rapidly (3?days or less), severely Inflamed tonsils and No cough or coryza (FeverPAIN) had moderate predictive value (bootstrapped area under the ROC curve 0.73 cohort 1, 0.71 cohort 2) and identified a substantial number of participants at low risk of streptococcal infection (38% in cohort 1, 36% in cohort 2 scored ?1, associated with a streptococcal percentage of 13% and 18%, respectively). A Centor score of ?1 identified 23% and 26% of participants with streptococcal percentages of 10% and 28%, respectively.

Conclusions: Items widely used to help identify streptococcal sore throat may not be the most consistent. A modified clinical scoring system (FeverPAIN) which requires further validation may be clinically helpful in identifying individuals who are unlikely to have major pathogenic streptococci.
1-19
Little, Paul
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Moore, Michael
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Hobbs, F.D.R.
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Mant, David
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McNulty, Cliodna
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Williamson, Ian
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Cheng, Edith
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Stuart, Beth
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Kelly, Joanne
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Barnett, Jane
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Mullee, Mark
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Leydon, Geraldine
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on behalf of the PRISM Investigators
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
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Hobbs, F.D.R.
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Mant, David
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McNulty, Cliodna
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Williamson, Ian
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Cheng, Edith
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Stuart, Beth
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Kelly, Joanne
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Barnett, Jane
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Mullee, Mark
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Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40

Little, Paul, Moore, Michael, Hobbs, F.D.R., Mant, David, McNulty, Cliodna, Williamson, Ian, Cheng, Edith, Stuart, Beth, Kelly, Joanne, Barnett, Jane, Mullee, Mark and Leydon, Geraldine , on behalf of the PRISM Investigators (2013) PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A ?-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat. BMJ Open, 3 (10), 1-19. (doi:10.1136/bmjopen-2013-003943). (PMID:24163209)

Record type: Article

Abstract

Objective: To assess the association between features of acute sore throat and the growth of streptococci from culturing a throat swab.

Design: Diagnostic cohort.

Setting: UK general practices.

Participants: Patients aged 5 or over presenting with an acute sore throat. Patients were recruited for a second cohort (cohort 2, n=517) consecutively after the first (cohort 1, n=606) from similar practices.

Main outcome: Predictors of the presence of Lancefield A/C/G streptococci.

Results: The clinical score developed from cohort 1 had poor discrimination in cohort 2 (bootstrapped estimate of area under the receiver operator characteristic (ROC) curve (0.65), due to the poor validity of the individual items in the second data set. Variables significant in multivariate analysis in both cohorts were rapid attendance (prior duration 3?days or less; multivariate adjusted OR 1.92 cohort, 1.67 cohort 2); fever in the last 24?h (1.69, 2.40); and doctor assessment of severity (severely inflamed pharynx/tonsils (2.28, 2.29)). The absence of coryza or cough and purulent tonsils were significant in univariate analysis in both cohorts and in multivariate analysis in one cohort. A five-item score based on Fever, Purulence, Attend rapidly (3?days or less), severely Inflamed tonsils and No cough or coryza (FeverPAIN) had moderate predictive value (bootstrapped area under the ROC curve 0.73 cohort 1, 0.71 cohort 2) and identified a substantial number of participants at low risk of streptococcal infection (38% in cohort 1, 36% in cohort 2 scored ?1, associated with a streptococcal percentage of 13% and 18%, respectively). A Centor score of ?1 identified 23% and 26% of participants with streptococcal percentages of 10% and 28%, respectively.

Conclusions: Items widely used to help identify streptococcal sore throat may not be the most consistent. A modified clinical scoring system (FeverPAIN) which requires further validation may be clinically helpful in identifying individuals who are unlikely to have major pathogenic streptococci.

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Accepted/In Press date: 3 October 2013
Published date: 25 October 2013
Additional Information: Geraldine Leydon: PRISM Investigator
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 359354
URI: https://eprints.soton.ac.uk/id/eprint/359354
PURE UUID: bcc5444b-3a19-42ec-a329-57c7b1951066
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300

Catalogue record

Date deposited: 29 Oct 2013 08:43
Last modified: 12 Nov 2019 01:47

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Contributors

Author: Paul Little
Author: Michael Moore ORCID iD
Author: F.D.R. Hobbs
Author: David Mant
Author: Cliodna McNulty
Author: Ian Williamson
Author: Edith Cheng
Author: Beth Stuart
Author: Joanne Kelly
Author: Jane Barnett
Author: Mark Mullee

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