SynthesisBMC medicine2011
Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score.
Synthesis in BMC medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
47 citing papers in PubMed, 4 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- Initial assessment and management of adults with suspected acute respiratory infection: a rapid evidence synthesis of reviews and cost-effectiveness studies.Health technology assessment (Winchester, England) · 2026Pooled it
- Rapid antigen detection and molecular tests for group A streptococcal infections for acute sore throat: systematic reviews and economic evaluation.Health technology assessment (Winchester, England) · 2020Pooled it
- Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Pooled it
- Clinical gestalt to diagnose pneumonia, sinusitis, and pharyngitis: a meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Pooled it
- Influence of a guideline or an additional rapid strep test on antibiotic prescriptions for sore throat: the cluster randomized controlled trial of HALS (Hals und Antibiotika Leitlinien Strategien).BMC primary care · 2023Trial
- Trial
- Screening for iron deficiency in young women: the predictive validity of a five-item screening instrument (IRON-5).Scandinavian journal of primary health care · 2026Article
- Article
- Treatment of Acute Sore Throat in Malaysia: A Consensus of Multidisciplinary Recommendations Using Modified Delphi Methodology.Infection and drug resistance · 2024Review
- Article
- Lemierre syndrome: a hidden complication of sore throats.International journal of emergency medicine · 2023Article
- Recrudescence of Scarlet Fever and Its Implications for Dental Professionals.International dental journal · 2023Review
- Diagnosis and management of acute pharyngotonsillitis among pediatric patients at Ribat Teaching Hospital: a prospective audit (2021-2022).Sudanese journal of paediatrics · 2023Article
- Role of multidimensional factors in the diagnosis and treatment of tonsillopharyngitis in primary care: a qualitative study.BMC primary care · 2022Article
- Article
- Diagnostic Accuracy of Centor Score for Diagnosis of Group A Streptococcal Pharyngitis among Adults in Primary Care Clinics in Malaysia.The Malaysian journal of medical sciences : MJMS · 2022Article
- A framework for implementing antibiotic stewardship in ambulatory care: Lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Review
- The aetiology of pharyngotonsillitis in primary health care: a prospective observational study.BMC infectious diseases · 2021Observational
- Influenza B presenting with bicytopenia in an adult - An unusual presentation and failure of antimicrobial stewardship by a practicing physician.Journal of family medicine and primary care · 2020Article
- Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010-2016.Emerging infectious diseases · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A β-haemolytic streptococcal (GABHS) pharyngitis in adults (> 14 years of age) presenting with sore throat symptoms.
methodsA systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used.
resultsA total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37).
conclusionsIndividual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care.
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Registered trials
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