Abstract
Objetivo
Determinar la validez de la puntuación de Centor (adenopatías cervicales, exudado amigdalar, fiebre y ausencia de síntomas catarrales) para filiar la faringoamigdalitis de origen estreptocócico.
Diseño
Estudio descriptivo.
Emplazamiento
Centro de Salud San Fernando 2 (zona periurbana de Madrid).
Participantes
Se incluyó a 140 pacientes mayores de 14 años que acudieron a la consulta entre el 14 de febrero y el 12 de mayo de 2005 con «dolor de garganta» como principal síntoma.
Mediciones principales
Se determinaron la sensibilidad (S), la especificidad (E), los valores predictivos postivo y negativo (VPP y VPN) y los cocientes de probabilidad de la puntuación de Centor; se utilizó el frotis faríngeo como método de referencia.
Resultados
En total, 34 pacientes presentaron frotis positivo (24,3%; intervalo de confianza [IC] del 95%, 17,6-32,4%). El hallazgo de los 4 criterios de Centor presentaba un VPP del 48,1% (IC del 95%, 30,7-66,0%) y un VPN del 81,4% (IC del 95%, 73,3-87,5%), aunque sólo la fiebre (odds ratio [OR] = 3,64; IC del 95%, 1,40- 9,49) y el exudado amigdalar (OR = 6,18; IC del 95%, 2,08-18,35) muestran asociación con la etiología estreptocócica.
Conclusiones
El sistema de puntuación clínica alcanza un alto VPN y una especificidad que permiten diagnosticar con bastante certeza las faringoamigdalitis no estreptocócicas. Sin embargo, su VPP es bajo: una puntuación alta (3 o 4 criterios) no asegura que sea una faringoamigdalitis estreptocócica. Queda por resolver qué actitud se debe adoptar ante estos pacientes con sospecha de faringitis estreptocócica: test microbiológico, antibioterapia inmediata o antibioterapia diferida.
Palabras clave: Faringitis, Streptococcus pyogenes, Atención primaria de salud, Sensibilidad y especificidad, Valor predictivo de los tests
Abstract
Objective
To determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab).
Design
Descriptive study.
Setting
San Fernando 2 Health Centre, Madrid (outer urban area), Spain.
Participants
On hundred forty patients over 14 years old who had a “sore throat” as main symptom and attended clinic between 14 February and 12 May, 2005.
Main measurements
Sensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method.
Results
Thirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology.
Conclusions
The high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty.What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic).
Key words: Pharyngitis, Streptococcus pyogenes, Primary health care, Sensitivity and specificity, Predictive value of tests
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