ArticleBMJ open2013
Streptococcal pharyngitis in children: a meta-analysis of clinical decision rules and their clinical variables.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- 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
- Selective testing strategies for diagnosing group A streptococcal infection in children with pharyngitis: a systematic review and prospective multicentre external validation study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015Pooled it
- A Nationwide Review of the Utilization of Rapid Antigen Testing for Group A Streptococcus.Cureus · 2026Article
- Use of point-of-care tests in pharyngotonsillitis - a registry-based study in primary health care.Scandinavian journal of primary health care · 2025Article
- Xiao'er Fengreqing oral liquid versus Xiao'er Yanbian granules for pediatric acute pharyngitis/tonsillitis (external wind heat syndrome): protocol and statistical analysis plan for a multi-center, randomized, double-blind, active drug-controlled trial.Frontiers in pharmacology · 2025Article
- Group A β-hemolytic Streptococcal Pharyngitis: An Updated Review.Current pediatric reviews · 2024Review
- Clinical decision rules in primary care: necessary investments for sustainable healthcare.Primary health care research & development · 2023Article
- Role of multidimensional factors in the diagnosis and treatment of tonsillopharyngitis in primary care: a qualitative study.BMC primary care · 2022Article
- Recent Advances in the Rheumatic Fever and Rheumatic Heart Disease Continuum.Pathogens (Basel, Switzerland) · 2022Review
- The aetiology of pharyngotonsillitis in primary health care: a prospective observational study.BMC infectious diseases · 2021Observational
- Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI.BMJ open respiratory research · 2020Review
- Clinical Features of Group A Streptococcus in Children With Pharyngitis: Carriers versus Acute Infection.The Pediatric infectious disease journal · 2020Article
- Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review.Frontiers in cellular and infection microbiology · 2020Review
- Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Observational
- Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective, multicenter study.PloS one · 2017Article
- Abdominal pain and nausea in the diagnosis of streptococcal pharyngitis in boys.International journal of general medicine · 2017Article
- Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis.Journal of clinical microbiology · 2016Article
- Acute rheumatic fever and rheumatic heart disease.Nature reviews. Disease primers · 2016 · on this mapReview
- Sore throat in primary care project: a clinical score to diagnose viral sore throat.Family practice · 2015Article
- Molecular and clinical diagnosis of group A streptococcal pharyngitis in children.Journal of clinical microbiology · 2014Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo identify the best clinical decision rules (CDRs) for diagnosing group A streptococcal (GAS) pharyngitis in children. A combination of symptoms could help clinicians exclude GAS infection in children with pharyngitis.
designSystematic review and meta-analysis of original articles involving CDRs in children. The Pubmed, OVID, Institute for Scientific and Technical Information and Cochrane databases from 1975 to 2010 were screened for articles that derived or validated a CDR on a paediatric population: 171 references were identified.
settingAny reference including primary care for children with pharyngitis. DATA EXTRACTION: The methodological quality of the articles selected was analysed according to published quality standards. A meta-analysis was performed to assess the statistical performance of the CDRs and their variables for the diagnosis of GAS pharyngitis. PRIMARY OUTCOME MEASURE: The main criterion was a false-negative rate in the whole population not any worse than that of a rapid diagnostic test strategy for all patients (high sensitivity and low negative likelihood ratio).
results4 derived and 12 validated CDRs for this diagnosis in children. These articles involved 10 523 children (mean age, 7 years; mean prevalence of GAS pharyngitis, 34%). No single variable was sufficient for diagnosis. Among the CDRs, that of Joachim et al had a negative likelihood ratio of 0.3 (95% CI 0.2 to 0.5), resulting in a post-test probability of 13%, which leads to 3.6% false-negative rate among low-risk patients and 10.8% overall, equivalent to rapid diagnostic tests in some studies.
conclusionsThe rule of Joachim et al could be useful for clinicians who do not use rapid diagnostic tests and should allow avoiding antibiotic treatment for the 35% of children identified by the rule as not having GAS pharyngitis. Owing to its poor specificity, such CDR should be used to focus rapid diagnostic tests to children with high risk of GAS pharyngitis to reduce the antibiotic consumption.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.