Modified Centor Score Research Articles

Explainable AI decision support improves accuracy during telehealth strep throat screening

BackgroundArtificial intelligence-based (AI) clinical decision support systems (CDSS) using unconventional data, like smartphone-acquired images, promise transformational opportunities for telehealth; including remote diagnosis. Although such solutions’ potential remains largely untapped, providers’ trust and understanding are vital for effective adoption. This study examines how different human–AI interaction paradigms affect clinicians’ responses to an emerging AI CDSS for streptococcal pharyngitis (strep throat) detection from smartphone throat images.MethodsIn a randomized experiment, we tested explainable AI strategies using three AI-based CDSS prototypes for strep throat prediction. Participants received clinical vignettes via an online survey to predict the disease state and offer clinical recommendations. The first set included a validated CDSS prediction (Modified Centor Score) and the second introduced an explainable AI prototype randomly. We used linear models to assess explainable AI’s effect on clinicians’ accuracy, confirmatory testing rates, and perceived trust and understanding of the CDSS.ResultsThe study, involving 121 telehealth providers, shows that compared to using the Centor Score, AI-based CDSS can improve clinicians’ predictions. Despite higher agreement with AI, participants report lower trust in its advice than in the Centor Score, leading to more requests for in-person confirmatory testing.ConclusionsEffectively integrating AI is crucial in the telehealth-based diagnosis of infectious diseases, given the implications of antibiotic over-prescriptions. We demonstrate that AI-based CDSS can improve the accuracy of remote strep throat screening yet underscores the necessity to enhance human–machine collaboration, particularly in trust and intelligibility. This ensures providers and patients can capitalize on AI interventions and smartphones for virtual healthcare.

Assessing the Diagnostic Accuracy and Validity of the Mcisaac Modified Centor Score in Predicting Group A Beta Hemolytic Streptococcal Pharyngitis in A Trial to End Antibiotic Abuse in Children

Assessing the Diagnostic Accuracy and Validity of the Mcisaac Modified Centor Score in Predicting Group A Beta Hemolytic Streptococcal Pharyngitis in A Trial to End Antibiotic Abuse in Children

Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study.

One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.

351 Can the Centor Score Be Used Effectively via Telehealth?

The modified Centor score is a validated clinical decision rule for estimating the likelihood of streptococcal pharyngitis in patients with less than three days of acute pharyngitis symptoms. The score then can be used to guide testing and treatment combined with other consensus recommendations. With the growth of telehealth, patients are frequently evaluated remotely using real-time audio video communication. It is important to better understand how traditionally in-person clinical decision support rules can be utilized in telehealth.

Positive Rate of Tests for Group a Streptococcus and Viral Features in Children with Acute Pharyngitis.

Group A streptococcus (GAS) is an important cause of acute pharyngitis. We investigated the positive rate of GAS tests and clinical viral features in children with acute pharyngitis. A retrospective review was conducted for patients <15 years old with both rapid antigen detection test (RADT) and throat culture results. Patients were excluded if they were diagnosed with influenza or had received antibiotics within two weeks before these tests. A total of 377 patients were eligible. The median age of patients was 3.5 years, and 45.4% of total patients were <3 years old. Among all patients, 68.7% had at least one viral feature, and 39% had more than two. The overall positiv rate for GAS was 11.4%. The GAS positive rate was significantly lower in patients <3 years old than in older patients (1.8% vs. 19.4%, p < 0.0001). The overall sensitivity and specificity of RADT were 75.0% (95% CI: 57.8–87.9) and 97.9% (95% CI: 95.8–99.2), respectively. The GAS positive rate was not significantly different between patients with and without viral features (12.4% vs. 9.3%, p = 0.4854). In patients aged 3–14 years, the GAS positive rate was not associated with the modified Centor score or the frequency of clinical viral features. Despite a low prevalence of GAS pharyngitis, testing for GAS was frequently performed in children <3 years old in this study. Appropriate use of laboratory testing for GAS pharyngitis and judicious prescription of antibiotics were imperative.

Antibiotic prescribing and use of corticosteroids for the emergency department management of acute uncomplicated pharyngitis.

Acute pharyngitis is common in the ambulatory setting. The Modified Centor score uses five criteria to predict Group A Streptococcus (GAS) infection and can be used to guide management. The objective of this study was to describe the emergency department (ED) management (throat cultures, antibiotics and corticosteroids) of acute, uncomplicated pharyngitis by Centor score. This was a retrospective chart review of adult (>17 years) patients with an ED discharge diagnosis of acute pharyngitis from January 2016 to December 2018. Of 638 patients included, 286 (44.8%) had a Centor score of 0-1, 328 (51.4%) had a score of 2-3 and 24 (3.8%) had a score of ≥4. Of those with a Centor score of 0-1, 83 (29.0%) had a throat culture, 88 (30.8%) were prescribed antibiotics, 15 (5.2%) were positive for GAS and 74 (25.9%) received corticosteroids. Of those with a Centor score of 2-3, 156 (47.6%) had a throat culture, 220 (67.1%) were prescribed antibiotics, 44 (13.4%) were positive for GAS and 145 (44.2%) received corticosteroids. Of those with a Centor score ≥4, 14 (58.3%) had a throat culture, 18 (75.0%) were prescribed antibiotics, 7 (29.2%) were positive for GAS and 12 (50.0%) received corticosteroids. A higher Centor score was associated with a higher risk of GAS infection, increased antibiotic prescribing and use of corticosteroids. Many patients with low Centor scores were prescribed antibiotics and had throat cultures. Further work is required to understand clinical decision-making for the management of acute pharyngitis.

COVID-19 findings revealed via otolaryngological examination: Findings of a Japan Otorhinolaryngologist Association questionnaire

ObjectiveIn Japan, many otolaryngologists provide primary care for patients with coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the characteristics of otorhinolaryngological findings in order to improve COVID-19 diagnostic systems in a primary care setting. MethodsA total of 351 patients (mean age, 36.0 ± 15.4 years) diagnosed with COVID-19 by otolaryngologists who belong to the Japan Otorhinolaryngologists Association were included in the study. A web-based questionnaire was used to collect information regarding the timing of positive identification of COVID-19, the route of infection, symptoms, and findings in the tonsils, nasal cavity, pharynx, ear, and neck. A modified Centor score was calculated for cases in which age, symptoms, and tonsil and neck findings were described. ResultsSymptoms included fever (56%), olfactory disturbance (46%), and a sore throat (56%). Of the individuals considered, 63% had ordinary rhinoscopic findings, 21% experienced watery rhinorrhea, and 12% had observable mucosal redness. Further, 87% had ordinary tonsillar findings, 13% displayed tonsillar redness, with enlargement and white mucus observe in 2% and 1% of participants, respectively. A total of 193 patients had a calculated Centor score of 3 points in 2%, and scores of the remaining participants were ≤2 points. ConclusionOf all patients considered, 40% had nasal findings and 4% had purulent nasal discharge. In contrast, only 13% of the patients had tonsillar findings, and no patients had Centor scores ≥4 points. Symptom differentiation from that of bacterial infections is difficult. In areas where COVID-19 is prevalent, the disease should be considered in patients presenting with fever, olfactory disturbances, and sore throat with minimal or no clinical findings in the nasal cavity and pharynx.

Trends in the use of antibiotics for pharyngitis in Saudi Arabia.

Pharyngitis is one of the most common diagnoses for antibiotic prescriptions worldwide. Antibiotics should be prescribed for bacterial pharyngitis to reduce its complications. The aims of this study were to assess antibiotic prescriptions for pharyngitis cases, and their relationship with physicians' knowledge regarding its diagnosis and management. A cross-sectional study was conducted. First, prescriptions for pharyngitis cases using the modified Centor criteria was evaluated at primary care centers in Saudi Arabia. Second, physicians' knowledge of the modified Centor score and the diagnosis and management of pharyngitis was assessed using a self-administered questionnaire. Out of 104 pharyngitis cases, 79% (n = 82) were prescribed antibiotics, of which 28% were evidence-based prescriptions. First-line antibiotics were prescribed in 34% of patients, and second-line (broad-spectrum) antibiotics such as amoxicillin/clavulanate were prescribed in half of the patients. The main significant predictors of antibiotic prescriptions were age < 3 years (odds ratio, 0.13; 95% CI, 0.02 to 0.97), tonsillar exudate (odds ratio, 21.14; 95% CI, 2.88 to 155.09), and throat erythema (odds ratio, 9.30; 95% CI, 1.18 to 73.41). Overall, physicians (n = 29) had adequate knowledge about the modified Centor score and the management of pharyngitis. Most prescribed antibiotics for pharyngitis were unnecessarily prescribed; the majority being broad-spectrum antibiotics. Despite physicians' adequate knowledge of the modified Centor score and the management of pharyngitis, their practice failed to demonstrate that. Induction of the Saudi Antimicrobial Stewardship Program in the primary care centers, accessibility to diagnostic tools, and educational programs may help in reducing unnecessary antibiotic prescriptions.

Evaluation of the Use of the Mistik Score and Modified Centor Score in Sore Throat

Objective: There are various clinical scoring systems in acute tonsillopharyngitis. The Modified Centor Score was developed to predict streptococcal pharyngitis and the Mistik score was developed to diagnose viral agents. This study aimed to determine cut-off values of the Modified Centor Score and Mistik score according to rapid antigen detection test (RADT) results of patients admitted with sore throat in the primary care and evaluate the use of these scoring systems by family physicians. Methods: A total of 125 patients between the ages of 3 and 80 who were admitted with sore throat to the family health centers were included in the study. Physical examinations of the patients were performed and their Mistik and Modified Centor Scores were detected. Patients underwent RADT. Treatments of the patients were recorded. In the second stage of the study, patients underwent clinical scoring and the physicians completed a questionnaire to evaluate the use of the Mistik Score, Modified Centor Score and RADT. Results: The optimal cut-off value for the Modified Centor Score was 3, sensitivity was 87.5%, specificity was 86.2%, positive predictive value was 48.3% and negative predictive value was 97.9%. The optimal cut-off value for Mistik score was 3, sensitivity was 61%, specificity was 87.5%, positive predictive value was 97% and negative predictive value was 25%. Of the physicians, 75% used clinical scoring during routine examination and the most common scoring system used was the Modified Centor Score (88.9%). Of the physicians, 75% used clinical scoring before the decision of RADT. Conclusion: The use of clinical scoring systems such as the Mistik Score and Modified Centor Score will primarily allow RADT be used in the appropriate patient for sore throat that is very common in daily family practice. In addition, it will help family physicians decide on the best treatment options for tonsillopharyngitis. Therefore, we recommend the use of clinical scoring systems especially the Mistik Score, which is a viral scoring system.

Efficacy of Rapid Antigen Test and McIsaac / Modified Centor Scores for Diagnosis of Streptococcal Tonsillopharyngitis in Children

Objective: We aimed to determine the efficacy of rapid antigen tests, clinical signs, and McIsaac / modified Centor clinical scoring systems in the diagnosis of Group A streptococcus (GAS) at children. Materials and Methods: Subjects aged 3-14 years who presented with acute tonsillopharyngitis were questioned about their sociodemographic properties and symptoms. Their clinical signs and McIsaac / modified Centor scores were recorded. They underwent a rapid streptococcal antigen test and throat culture sampling. Results: GAS proliferated in culture %11 of cases. The risk of culture positivity was 4.8 times greater in children aged 6 years or older. There was a significant correlation between culture positivity and muscle pain, tonsillar edema. Rapid strep test had a sensitivity of 75% and a specifity of 100% for the diagnosis of streptococcal tonsillopharyngitis. Rapid strep test showed a sensitivity of 80% and a specifity of 100% in children with a McIsaac / modified Centor score of 4-5. Conclusions: Unnecessary antibiotic use for tonsillopharyngitis is an important problem. Therefore, it is ideal to order throat culture and act accordingly in every case suggesting GAS infection. However, when culture is not possible, rapid strep testing and McIsaac / modified Centor scoring are effective in guiding diagnosis and treatment.

Rapid Antigen Detection Test Using Rates of Family Physicians, Test Results and Its Impact on Their Prescription Behaviours

Aim: The aim of this study is to determine the rates of rapid antigen detection test use, test results and its relationship with Modified Centor Score and investigate the effect of rapid antigen detection test use on prescribing behaviour. Methods: This research was conducted by scanning the family physicians’ information system retrospectively. From the Family Medicine Information System, where polyclinics and prescription records of the family health centers where 12 family physicians work in Kayseri are located, the number and results of rapid antigen detection tests performed between February 2017 and April 2019, the Modified Centor Score automatically calculated by the system, the number of prescribed antibiotics and symptomatic treatment information was recorded. Results: The positivity of rapid antigen detection test was considered, cut-off value of Modified Centor Score was &gt;2 (ROC EAA:63.9, Cl:0.95,0.61-0.66). Sensitivity rate of the test for diagnostic score was 86% and selectivity rate was 48.8%. Conclusion: Family physicians should be encouraged to use rapid antigen detection test. The fact that antibiotics are prescribed in rapid antigen detection testnegative patients may indicate that confidence level of the test is less than physical examination and clinical findings. Keywords: sore throat, primary care, score

Pattern of Antibiotic Prescription for Upper Respiratory Tract Infections among Under-Fives in Outpatient Clinics in Tharaka-Nithi County

The World Health Organization (WHO) qualified antimicrobial resistance (AMR) as one of the principal threats to public health globally and inappropriate antibiotic prescription is its modifiable contributor. Therefore assessing antibiotic prescriptions for URTI is an acceptable way to analyze the appropriateness of the prescriptions. However, there is a paucity of data regarding the pattern of antibiotic prescriptions in rural hospitals in Kenya. This study seeks to profile the pattern of antibiotic prescriptions among under-fives with URTI in Tharaka-Nithi County, Kenya. This was a retrospective charts review of under-fives treated from November 2018 to December 2019 for URTI in outpatient clinics in Chogoria and Chuka hospitals. A systematic sampling of 385 charts was carried out using the table of Robert and Morgan based on the total of 5000 URTI cases recorded. Charts of children with suspected bacterial infections were excluded, and for cases of tonsillitis, only children with a modified Centor score ≤3 were included. The binary logistic regression was used to assess the association between variables with the calculation of Odd ratio with a CI of 95% using SPSS 24. This study found that 70.4% of under-fives with URTI were prescribed antibiotics. The prescriptions were associated with the diagnosis of tonsillitis as part of the URTI, OR 21(95%CI 4.52-99.3); the level of education of the prescriber with clinical officers prescribing more than medical officers, OR 15.9(95%CI 6.98-36.2) and the patient’s proximity to the hospital, OR 1.77(95%CI 1.22-2.77). Antibiotics were prescribed to 70.4% of URTI cases. This percentage was higher than the 30% expected by WHO and was significantly associated with the diagnosis of tonsillitis, the level of education of the prescriber and hospital accessibility. There is a need to train clinicians about the indications of antibiotic prescriptions and to implement antimicrobial stewardship programs in rural facilities.

Impact of viral symptoms on the performance of the modified centor score to predict pediatric group A streptococcal pharyngitis

BackgroundClinicians use the Modified Centor Score (MCS) to estimate the risk of group A streptococcal (GAS) pharyngitis in children with sore throat. The Infectious Diseases Society of America (IDSA) recommends neither testing nor treating patients with specific viral symptoms. The goal of this study is to measure the impact of those symptoms on the yield of GAS testing predicted by the MCS. Methods Retrospective cohort study of all patients aged 3–21 years presenting with sore throat and tested for GAS in a pediatric emergency department (ED) in 2016. After identifying all patients tested for GAS, we used natural language processing (NLP) to identify the subgroup complaining of sore throat. We abstracted all MCS variables as well as symptoms suggestive of a viral etiology per the IDSA guideline (conjunctivitis, coryza, cough, diarrhea, hoarseness, ulcerative oral lesions, viral exanthema). We calculated the proportion of patients who tested positive for GAS by MCS with and without viral symptoms. ResultsOf the 1574 patients included, 372 patients (24%) tested GAS positive. Patients with at least one viral symptom had a reduced GAS risk compared to those without any of the viral symptoms 91/547 (17% GAS positive) vs. 281/1027 (27%), odds ratio 0.53 (95% CI 0.41–0.69). ConclusionsThe presence of viral symptoms specified by the IDSA alters the predicted yield of testing by traditional MCS. Clinicians may consider adjusting interpretation of a patient′s MCS based on the presence of viral symptoms, but viral symptoms may not always fully obviate the need for GAS testing.

Management of sore throat in Danish general practices

BackgroundThe national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline.MethodsA cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients.ResultsIn total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%).ConclusionDanish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.

McIsaac Modification of Centor Score in Diagnosis of Streptococcal Pharyngitis and Antibiotic Sensitivity Pattern of Beta-hemolytic Streptococci in Chennai, India

To assess the validity of modified Centor Score in predicting streptococcal pharyngitis, and describe the antibiotic sensitivity of streptococcal strains. A cross-sectional study of 120 children (age 1-18 y) with signs and symptoms of pharyngitis was undertaken in the pediatric department of a tertiary care teaching hospital in Chennai from July 2015 to April 2016. Modified Centor score was calculated for all children, and streptococcal sore throat was confirmed by throat swab culture. Predictive validity of Centor score was assessed by Receiver Operating Curve (ROC) analysis. Streptococcal culture positivity was 35%. The Area Under the Curve (AUC) value for modified Centor score was 0.589 (95% CI 0.481 to 0.697, P=0.11) in predicting streptococcal pharyngitis. Cough had the highest sensitivity (63.4%), but poor specificity (36.7%) for streptococcal pharyngitis confirmed by culture. The specificity was 100% for palatine petechiae, followed by palatine exudates (97.5%) and tender anterior cervical nodes (88.6%) to diagnose streptococcal pharyngitis. The proportion of antibiotic resistance was highest for cotrimoxazole (16.7%). Predictive validity of modified Centor score was not satisfactory, and resistance to cotrimoxazole, fluoroquinolones and macrolides was high among S. pyogenes strains.

Beta-Hemolytic Nongroup A Streptococcal Pharyngitis in Children

To evaluate the epidemiology, clinical features, and antibiotic prescribing patterns for nongroup A streptococci (NGAS) in children. Throat cultures obtained for pharyngitis were assessed at a large community-based health system over 10 years. Epidemiologic and clinical features of children with NGAS were compared with children with group A Streptococcus (GAS) and negative cultures. Antibiotic prescribing patterns were evaluated. A total of 224 328 rapid streptococcal antigen tests and 116 578 throat cultures were performed. Clinical analysis was completed for 602 GAS-positive patients, 535 NGAS-positive patients, and 480 patients with negative cultures. Incidence of NGAS did not vary annually or by season but increased with age from 2% at ≤5 years to 7% at 18 years of age. Patients with NGAS were more likely than those with negative cultures to have tonsillar exudate (20.3% vs 13.1%, P = .003) and enlarged tonsils (28.6% vs 19.3%, P < .001). Modified Centor scores did not differ between groups (score ≥2, P = 1.0; score ≥3, P = .50). Patients with GAS were more likely than those with NGAS to have fever (32.6% vs 24.5%, P = .003), palatal petechiae (14.0% vs 3.1%, P < .001), and modified Centor score ≥2 (47.8% vs 27.1%; P < .001). Of patients with NGAS, 65% were prescribed antibiotics. NGAS likely exist in both carriage and infectious states and incidence increases with age. Infections associated with NGAS are milder than with GAS, and complications are rare. Laboratory reporting of NGAS results in high antibiotic use, despite current recommendations against treatment.

1454. Β-Hemolytic Non-Group A Streptococcus Pharyngitis in Children

BackgroundNon-Group A Streptococci (NGAS) are common isolates from patients with pharyngitis. Few studies have assessed the epidemiology and clinical features of these infections in children.MethodsThe epidemiology, clinical features, and antibiotic prescribing patterns for NGAS among children with throat cultures obtained for pharyngitis were assessed at a large community-based health system over 10 years. Children with NGAS were compared with children with Group A Streptococcus (GAS) and negative cultures using uni- and multi-variate analysis. Antibiotic prescribing patterns were evaluated.ResultsA total of 224,328 rapid Streptococcus tests and 116, 578 throat cultures were performed. Clinical analysis was completed for 602 GAS patients, 535 NGAS patients, and 480 patients with negative cultures. Incidence of NGAS did not vary annually or by season, but increased with age from 2% at ≤ 5 years to 7% at 18 years. Patients with NGAS were more likely than those with negative cultures to have exudates (20.3% vs. 13.1%, P = 0.003) and enlarged tonsils (28.6% vs. 19.3%, P < 0.001). Modified Centor scores did not differ between groups (score>2, P = 1.0; score>3, P = 0.50). Patients with GAS were more likely than those with NGAS to have fever (32.6% vs. 24.5%, P = 0.003), petechiae (14.0% vs. 3.1%, P < 0.001) and modified Centor score >2 (47.8% vs. 27.1%; P < 0.001). Of patients with NGAS 65% were prescribed antibiotics.ConclusionNGAS likely exists in both a carriage and infectious state and the incidence increases with age. When NGAS causes infection the infection is milder than GAS and complications are rare. Laboratory reporting of NGAS results in high antibiotic use, despite current recommendations against treatment.Disclosures All authors: No reported disclosures.

Rapid antigen test use for the management of group A streptococcal pharyngitis in community pharmacies.

Despite group A streptococci being an infrequent cause of pharyngitis in adult outpatients, sore throat remains a common indication for antibiotic prescription. This prospective multicentre non-randomised study describes a community pharmacy-based antimicrobial stewardship intervention consisting in the implementation of rapid antigen testing (RAT) for the management of adults with sore throat. Trained pharmacists triaged patients presenting with symptoms of pharyngitis using the modified Centor score. Those at risk for streptococcal infection were tested with RAT. Patients with a positive RAT were invited to consult a physician, whereas others were offered a symptomatic treatment. All patients received educational leaflets and were asked to fill in a follow-up form 7days later. Ninety-eight pharmacies in one French region participated, and 559 patients were included over 6months. RAT was proposed in 367 (65.7%) cases, and it was positive in 28 (8.3%). The follow-up form was returned by 140 (38.5%) participants. Of these, 10/10 patients with positive RAT further consulted a physician and were prescribed an antibiotic treatment, whereas 96.5% (110/114) of patients with negative results and not having any other reason to seek for doctor's advice did not consult. All participants found the intervention useful. Pharmacists spent 6-15min to perform the intervention, and 98.6% (73/74) of pharmacists giving a feedback declared to be ready to implement this intervention in daily practice, if endorsed and reimbursed. Our results suggest that a pharmacy-based programme for the management of sore throat is feasible and could increase adherence to guidelines.

Patient and Parent-Reported Signs and Symptoms for Group A Streptococcal Pharyngitis.

Identifying symptomatic patients who are at low risk for group A streptococcal (GAS) pharyngitis could reduce unnecessary visits and antibiotic use. The accuracy with which patients and parents report signs and symptoms of GAS has not been studied. Our objectives were to measure agreement between patient or parent and physician-reported signs and symptoms of GAS and to evaluate the performance of a modified Centor score, based on patient or parent and physician reports, for identifying patients at low risk for GAS pharyngitis. Children 3 to 21 years old presenting to a single tertiary care emergency department between October 2013 and January 2015 were included if they complained of a sore throat and were tested for GAS. Patients or parents and physicians completed surveys assessing signs and symptoms to determine a modified age-adjusted Centor score for GAS. We evaluated the overall agreement and κ between patient or parent and physician-reported signs and symptoms and compared the performance of the scores based on assessments by patients or parents and physicians and the risk of GAS. Of 320 patients enrolled, 107 (33%) tested GAS positive. Agreement was higher for symptoms (fever [agreement = 82%, κ = 0.64] and cough [72%, 0.45]) than for signs (exudate [80%, 0.41] and tender cervical nodes [73%, 0.18]). Agreement was highest when no signs and symptoms contained in the Centor score were present (94%, κ = 0.61). The proportion of patients testing GAS positive rose as the modified Centor score increased. For identifying GAS pharyngitis, patients or parents and physicians showed moderate to substantial agreement for 3 of 4 key pharyngitis signs and symptoms.

LO069: Current management of pharyngitis in the emergency department: a retrospective multicenter observational study

Introduction: Pharyngitis is a common presenting complaint at the emergency department (ED). Historically, acute pharyngitis has been overdiagnosed as the result of a bacterial etiology, leading to over-prescription of antibiotics, and overuse of throat culturing. This study attempts to quantify the current management of acute pharyngitis in the ED, and compare to the theoretical management using a modified Centor score. Methods: This was a retrospective chart review of 1640 patients who presented to four EDs in the central zone of the Nova Scotia Health Authority that received a diagnosis of pharyngitis, bacterial pharyngitis or tonsillitis. The primary outcome was the observed rate of each diagnosis in the study population, the rate of antibiotic prescription, and the rate of throat swab cultures performed. The secondary outcomes were the rate of antibiotics and throat swabs ordered using a modified Centor score. Antibiotics as first-line treatment were indicated if the Centor score was three or greater, and throat cultures were indicated if the Centor score was two or greater. Results: A total of 1596 patients were included in the analysis. Antibiotics were given in 893 patients (0.559; 95% CI: {0.535, 0.584}). Cultures were sent on 863 patients (0.541 CI: {0.516, 0.565}). Using the modified Centor thresholds, we would have prescribed antibiotics as the first-line treatment in 77 cases (0.048 CI: {0.038, 0.060}), potentially saving 786 prescriptions, and ordered throat swabs on 502 patients (0.315, CI: {0.292, 0.338}), saving 361 cultures. The most commonly prescribed antibiotic was penicillin, and the least prescribed was metronidazole. Conclusion: Over half of patients that present with acute pharyngitis receive an antibiotic, and over half have a throat swab culture performed. Utilizing a modified Centor score would result in decreased antibiotic prescription rate, and a diminished rate of throat cultures. Incorporation of these Centor criteria could result in diminished antibiotic prescription rates for acute pharyngitis in the ED.