Abstract
BackgroundObjective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice.Design: Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'.Setting: A solo family practice in rural New South Wales, AustraliaParticipants: Patients attending with sore throat.MethodsPatients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs) were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to < 16 yrs old) were asked to complete a similar, guardian questionnaire.Main outcome measures:1. Ability of a new scorecard to differentiate between bacterial and non-bacterial sore throat.2. Patients' trust in the scorecard.ResultsThe scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity.There was a high level of patient trust in the scorecard was (85.8% agreement). Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement).ConclusionsAs the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection.
Highlights
The management of sore throat in general practice is traditionally based on the doctor’s clinical judgment and empirical treatment
As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection
When the result favours a bacterial sore throat, a high sensitivity can mean that there are a number of false positives
Summary
The management of sore throat in general practice is traditionally based on the doctor’s clinical judgment and empirical treatment. As the rate of prescribing remains quite high for a condition mostly due to viral causes, distinguishing between non-bacterial and bacterial causes of sore throat is still important [1]. Clinical scoring systems have been developed to help recognise bacterial or non-bacterial sore throats, e.g. Centor’s and Breese’s criteria, which are based on 4 and 9 items respectively, and which only use clinical variables (see Table 1). An accurate scorecard will remain valuable whenever alternative techniques for identifying bacterial or non bacterial causes, such as rapid antigen testing and throat swab culture, are unaffordable, unavailable or impractical. Objective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice. Setting: A solo family practice in rural New South Wales, Australia Participants: Patients attending with sore throat
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
