Risk Stratification
Group A Streptococcal infection is more likely in the winter/spring, and in children aged 5-15.
To differentiate between viral causes, and the potentially more serious GABHS infection, a number of tools have been developed to assess the probability of GABHS infection and therefore the need for antibiotic treatment.
The two recommended by NICE [15] are FeverPAIN and CENTOR.
FeverPAIN Score 0-5 (Each scores 1 point)
Fever over 38 C.
Purulence (pharyngeal/tonsillar exudate)
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
CENTOR Score 0-4 (Each scores 1 point)
Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38 C)
Absence of cough
A modified version of CENTOR adds in age to increase accuracy, but is not currently included in NICE guidance [10].
Scores and subsequent likelihood of isolating Streptococcus [15].
| FeverPAIN | CENTOR | ||
|---|---|---|---|
| 0 – 1 | 13 – 18% | 0 | 3% |
| 2 – 3 | 34 – 40% | 1 | 7% |
| 4 – 5 | 62 – 65% | 2 | 15% |
| 3 | 32% | ||
| 4 | 56% | ||
Learning bite
A sore throat score is useful in predicting the likelihood of GABHS infection and can reduce unnecessary antibiotic prescriptions by 50%.
Note that these scores are not applicable to other causes of sore throat other than tonsillopharyngitis.