Should nurses in Israeli primary care clinics be expecte to manage streptococcal throat infections?

Abstract

IntroductionLegal regulations in Israel allow nurses to perform only limited clinical procedures. ObjectiveTo determine the probability of streptococcal infection in adults with sorethroat, as assessed clinically by standard nursing procedures. DesignUsing throat culture as the standard, the contribution of various clinical findings (fever, exudate, erythrocyte sedimentation rate (ESR), white blood count) to the determination of the diagnosis of streptococcal infection was assessed, using logistic regression analysis. SettingIsraeli general practice. Patients100 consecutive adult patients presenting with a red, sore throat. ResultsSix patients showed the full clinical picture of exudate, increased ESR andleukocytosis, with an 82% probability of streptococcal infection. Forty-nine patients showed none of these three findings, and only one of them (among the three patients with rhinitis) had a positive throat swab. Forty-five patients showed an intermediate clinical picture which did not provide a reliable basis for the diagnosis or exclusion of streptococcal infection. Fever alone did not significantly (P<0.05) predict streptococcal infection. ConclusionsNurses may safely discharge adult patients with a red, sore throat without antibiotic treatment only if they have no additional signs or symptoms. The few patients with all the clinical findings may be treated with antibiotics without a throat swab. All other patients should be referred for examination by a doctor.