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Clinical Application of a Scoring System in the Diagnosis of Group A Streptococcal Pharyngitis

Journal of the Korean Pediatric Society 1998;41(10):1365-1371.
Published online October 15, 1998.
Clinical Application of a Scoring System in the Diagnosis of Group A Streptococcal Pharyngitis
Hyeon-Bu Kim1, Byung-Soo Cho1, Sung-Ho Cha1, Jeong-Hun Ha2, Sun-Hee Kim3, Gui-Sook Cho4
1Department of Pediatrics, College of Medicine, Kyung-Hee University, Seoul, Korea
2Ha`s Pediatric Clinic
3Sewon Pediatric Clinic
4Choi`s Pediatric Clinic
A군 연쇄구균 인두염 진단에서 점수제의 임상 적용에 관한 연구
김현부1, 조병수1, 차성호1, 하정훈2, 김선희3, 최귀숙4
1경희대학교 의과대학 소아과학교실
2하정훈 소아과의원
3세원 소아과의원
4최귀숙 소아과의원
Correspondence: 
Sung-Ho Cha, Email: 1
Abstract
Purpose
: A scoring system could be clinically useful in determining cases in which a throat culture may be omitted or in cases whether antibiotics may be initiated or not. We propose to make a clinical guideline of antibiotics administration in patients with pharyngitis.
Methods
: From Apr. 1996. to Mar. 1997, throat cultures were taken from 321 cases(72 cases from Kyung-Hee Medical Center, 249 cases from 3 local pediatric clinics). On the first day of visit, 9 clinical items on a score-card were checked and a tentative diagnosis for streptococcal or non-streptococcal infection was made. These clinical scores were compared with the results of the throat swab cultures.
Results
: Of 321 cases with pharyngitis, 55 cases(17%) proved to have group A streptococci by throat culture. The positive culture rate of group A streptococci was 18.5% from 3 local pediatric clinics, and 12.5% from Kyung-Hee Medical Center. The positive culture rate of group A streptococci were 40% in above 31 points of score, 31.5% in 29 to 30 points, 20.5% in 27 to 28 points. The sensitivity and specificity of the scoring system using a score at least 28 above points were 71% and 67%, respectively.
Conclusion
: The clinical diagnosis of streptococcal pharyngitis indicates that patients age 5 to 10 years, findings of abnormal pharynx, high fever and no past history of antibiotics use. Further modification of the scoring system for diagnosis of streptococcal pharyngitis should be made to prevent antibiotics abuse and correct diagnosis of pharyngitis.
Key Words: Scoring system, Pharyngitis, Group A streptococci, Throat culture


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