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. 2005 Jun 7;90(10):1066–1070. doi: 10.1136/adc.2004.069120

Evaluation of the WHO clinical decision rule for streptococcal pharyngitis

A Rimoin 1, H Hamza 1, A Vince 1, R Kumar 1, C Walker 1, R Chitale 1, A L A da Cunha 1, S Qazi 1, M Steinhoff 1
PMCID: PMC1720142  PMID: 15941772

Abstract

Aims: To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS) pharyngitis in three countries.

Methods: A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2–12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis.

Results: The proportion of children presenting with sore throat and found to have GABHS pharyngitis ranged from 24.6% (Brazil) to 42.0% (Croatia). WHO CDR sensitivity was low for all sites in both age groups. In children age 5 or older, sensitivity ranged from 3.8% in Egypt to 10.8% in Brazil. In children under 5, sensitivity was low (0.0–4.6%) Specificity was high in both age groups in all countries (93.8–97.4%).

Conclusions: In these populations, the current WHO CDR has high specificity, but low sensitivity; it did not detect up to 96.0% of children who have laboratory confirmed GABHS pharyngitis. A CDR with higher sensitivity should be developed for use in regions where rheumatic fever and rheumatic heart disease are still major health problems.

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Figure 1.

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 Sensitivity and specificity of selected clinical decision rules.13–16,19 Breese: CDR considered positive for a score of 26 or higher out of a possible score of 38, based on a complex weighted score using nine features.13 McIsaac: CDR considered positive for presence of four of six features.14 Wald: CDR considered positive based on presence of four of six features.15 Steinhoff: CDR considered positive for presence of tonsillar exudate or enlarged cervical lymph nodes.16

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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