Diagnostic accuracy of FEVER-Pain and Centor criteria for bacterial throat infection in adults with sore throat: a secondary analysis of a randomised controlled trial

Anna Seeley*, Thomas R Fanshawe, Merryn Voysey, Alastair D Hay, Michael Moore, Gail Hayward

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background: Sore throat is a common and self-limiting condition. There remains ambiguity in stratifying patients to immediate, delayed or no antibiotic prescriptions. NICE recommends two clinical prediction rules (CPRs), FeverPAIN and CENTOR, to guide decision-making. Aim: Describe the diagnostic accuracy of CPRs in identifying streptococcal throat infections. Design and Setting: Adults presenting to UK primary care with sore throat, who did not require immediate antibiotics. Methods: As part of the Treatment Options without Antibiotics for Sore Throat (TOAST) trial, 565 participants, aged ≥ 18, were recruited on day of presentation to general practice. Physicians could opt to give delayed prescriptions. CPR scores were not part of the trial protocol but calculated post-hoc from baseline assessments. Diagnostic accuracy was calculated by comparing scores to throat swab cultures. Results: 81/502 (16.1%) of patients had Group A, C or G streptococcus cultured on throat swab. Overall diagnostic accuracy of both CPRs was poor: area under receiver-operating-characteristics curve 0.62 for Centor; 0.59 for FeverPAIN. Post-test probability of a positive or negative test was 27.3% (95% confidence intervals: 6.0-61.0%) and 84.1% (80.6-87.2%) for FeverPAIN ≥4, versus 25.7% (16.2-37.2%) and 85.5% (81.8-88.7%) for Centor ≥3. Higher CPR scores were associated with increased delayed antibiotic prescriptions (2 = 8.42, p=0.004 for FeverPAIN ≥4; 2 = 32.0, p<0.001 for Centor ≥3). Conclusions: In those that do not require immediate antibiotics in primary care, neither CPR provide a reliable way of diagnosing streptococcal throat infection. However, clinicians were more likely to give delayed prescriptions to those with higher scores.
Original languageEnglish
JournalBritish Journal of General Practice Open
Publication statusAccepted/In press - 28 Jul 2021

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