Evaluation of the WHO clinical decision rule for streptococcal pharyngitis. Issue 10 (7th June 2005)

• Record Type: Journal Article
• Authors: Rimoin, A W; Hamza, H S; Vince, A; Kumar, R; Walker, C F; Chitale, R A; da Cunha, A L A; Qazi, S; Steinhoff, M C
• Is Part Of: Archives of disease in childhood. Volume 90:Issue 10(2005)
• Page Start: 1066
• Page End: 1070
• Publication Date: 2005-06-07
• Subjects: ARI, acute respiratory infection -- CDR, clinical decision rule -- GABHS, group A β haemolytic streptococcal -- GNI, gross national income -- NPV, negative predictive value -- PPV, positive predictive value -- RF, rheumatic fever -- RHD, rheumatic heart disease -- WHO, World Health Organisation; group A beta haemolytic streptococcal pharyngitis -- GABHS -- streptococcal pharyngitis -- developing regions -- clinical decision rule -- diagnosis; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/adc.2004.069120
• Languages: English
• ISSNs: 0003-9888

Abstract

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.