Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis

Abstract

Quiz Ref IDGroup A streptococcal (GAS) pharyngitis is the most common cause of bacterial pharyngitis affecting over half a billion people annually worldwide.1 GAS pharyngitis is both the antecedent for invasive streptococcal infections such as necrotizing fasciitis and the postinfectious immunologic complication of rheumatic fever and/or rheumatic heart disease, a leading cause of cardiovascular morbidity and mortality in many developing parts of the world. Physical examination of the posterior oropharynx is an inaccurate method to distinguish GAS from other causes of acute pharyngitis,2 so Snow and others,3 most importantly Quiz Ref IDthe Centers for Disease Control and Prevention (CDC) and the American College of Physicians–American Society of Internal Medicine (ACP-ASIM), endorse applying the 4-point Centor clinical scoring scale4 to classify the risk of GAS and guide management of acute pharyngitis in adults (Table 1). Developed 3 decades ago and based on the evaluation of 286 adults at a single emergency department, the Centor score helps clinicians to distinguish GAS from viral pharyngitis and thereby to appropriately prescribe antibiotics to alleviate symptoms and decrease the rates of acute rheumatic fever, suppurative complications, missed school and work days, and disease transmission.5