Description of clinical prediction rules for group A streptococcal infection
| Clinical prediction rule | Presentation | Clinical predictors | Suggested course of action in the original study | Present validation study |
|---|---|---|---|---|
| Forsyth36 | List | Temperature, enlarged tender nodes (1 or ≥ 2), exudate (1 patch, ≥ 2 patches or confluent, purulent exudate), infectious mononucleosis syndrome (mucoid exudate and multiple small nodes), influenzal syndrome (fever and myalgia but no exudate or adenitis) | Clinically nonstreptococcal: culture; treat symptomatically | NA |
| Clinically “questionable”: culture; treat symptomatically | ||||
| Clinically streptococcal: do not culture; give penicillin orally | ||||
| Breese39 | Score | Month in which the patient is seen, age, leukocyte count, fever ≥ 100.5°F, sore throat, cough, headache, abnormal pharynx (redness, swelling, exudate, petechiae, “doughnut lesions” or ulcerations), abnormal cervical nodes (very enlarged without tenderness or if palpable and tender) | No clear course of action suggested | ≤ 25: no rapid antigen detection testing, no antibiotic treatment |
| 26–31: antibiotic with positive test result | ||||
| ≥ 32: no testing, antibiotic treatment | ||||
| Fujikawa41 | Score | Fever > 37.5C°, sore throat, nausea or vomiting, anorexia, absence of cough or rhinorrhea, pharynx (dark red or petechiae), cervical lymph node swelling, tonsillar exudate (white spotty), rash (scarlet fever-like, erythema or urticaria), strawberry tongue or marked papillae | No clear course of action suggested | NA |
| Wald42 | Score | Age, season, fever ≥ 38.3°C, adenopathy (cervical lymph nodes ≥ 1 cm or tender to palpation), pharyngitis (erythema, swelling or exudate of pharynx or tonsils), no upper respiratory symptoms (rhinorrhea, cough or conjunctivitis) | No clear course of action suggested | ≤ 1: no rapid antigen detection testing, no antibiotic treatment |
| 2–4: antibiotic with positive test result | ||||
| ≥ 5: no testing, antibiotic treatment | ||||
| Edmond38 | Decision tree | Age, scarlatiniform rash, pharyngotonsillitis (diffuse pharyngeal erythema and swollen, edematous tonsils), tender cervical nodes | Risk < 20%: consider symptomatic treatment only | < 20%: no rapid antigen detection testing, no antibiotic treatment |
| Risk 20%–60%: culture with or without penicillin therapy | 20%–60%: antibiotic with positive test result | |||
| Risk > 60%: penicillin therapy | > 60%: no testing, antibiotic treatment | |||
| McIsaac40 | Score | Temperature > 38°C, no cough, tender anterior cervical adenopathy, tonsillar swelling or exudate, age | 0–1: no culture or antibiotic required | 0–1: no rapid antigen detection testing, no antibiotic treatment |
| 2–3: culture all; treat only if result is positive | 2–3: antibiotic with positive test result | |||
| ≥ 4: culture all or treat with penicillin on clinical grounds | ≥ 4: no testing, antibiotic treatment | |||
| Attia43 | Score | Scarlatiniform rash, moderate to severe tonsillar swelling, moderate to severe tenderness and enlargement of cervical lymph nodes, absence of moderate to severe coryza | No clear course of action suggested | 0: no rapid antigen detection testing, no antibiotic treatment |
| 1–3: antibiotic with positive test result | ||||
| ≥ 4: no testing, antibiotic treatment | ||||
| Joachim37 | Score | Age, bacterial signs (tender cervical node, headache, petechiae on the palate, abdominal pain, sudden onset [< 12 h]), viral signs (conjunctivitis, coryza, diarrhea) | ≤ 2: no rapid antigen detection testing, symptomatic treatment | ≤ 2: no rapid antigen detection testing, no antibiotic treatment |
| 3: antibiotic with positive result on rapid antigen detection testing | 3: antibiotic with positive test result | |||
| ≥ 4: no rapid antigen detection testing, antibiotic treatment | ≥ 4: no testing, antibiotic treatment |
Note: NA = not applicable (the clinical prediction rule could not be validated).