Clinical features predicting group A streptococcal pharyngitis in a Japanese paediatric primary emergency medical centre. Issue 5 (May 2018)

• Record Type: Journal Article
• Authors: Nishiyama, Masahiro; Morioka, Ichiro; Taniguchi-Ikeda, Mariko; Mori, Takeshi; Tomioka, Kazumi; Nakanishi, Keita; Fujimura, Junya; Nishimura, Noriyuki; Nozu, Kandai; Nagase, Hiroaki; Ishibashi, Kazuto; Ishida, Akihito; Iijima, Kazumoto
• Is Part Of: Journal of international medical research. Volume 46:Issue 5(2018)
• Page Start: 1791
• Page End: 1800
• Publication Date: 2018-05
• Subjects: Age -- body temperature -- Group A Streptococcus -- McIsaac score -- pharyngitis -- rash; Medicine -- Periodicals; Pharmacology -- Periodicals; 610.5
• DOI: 10.1177/0300060517752954
• Languages: English
• ISSNs: 0300-0605

Abstract

Objectives: To identify clinical features that predict Group A streptococcal (GAS) pharyngitis in a Japanese paediatric primary emergency medical centre. Methods: The prevalence of GAS pharyngitis according to age and body temperature (BT) was calculated among 3098 paediatric patients with pharyngitis. The numbers of GAS-positive and -negative patients for each clinical parameter, and each point increase in the McIsaac score were compared and likelihood ratios (LRs) were calculated. Results: The prevalence of GAS pharyngitis was extremely low in patients aged < 1 (1.2%) and 1 year (3.9%). The GAS-positive rate was significantly higher in patients with a BT < 38.0°C compared with ≥ 38.0°C (30.0% vs. 19.8%). A BT ≥ 38.0°C was not a predictive finding for GAS pharyngitis (positive LR: 0.82). Rash was the most useful individual predictor, and a McIsaac score of 4 or 5 increased the probability; however, the positive LRs were 1.74 and 1.30, respectively. Conclusions: The prevalence of GAS pharyngitis is extremely low in patients aged < 1 and 1 year, and a BT ≥ 38.0°C is not a predictive symptom. Although a rash and McIsaac score of 4 or 5 are associated with an increased probability, they cannot be used to confirm GAS infection.