ArticleBJGP open2021
Diagnostic accuracy of Fever-PAIN and Centor criteria for bacterial throat infection in adults with sore throat: a secondary analysis of a randomised controlled trial.
Article in BJGP open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 21 citations in OpenAlex.
- Morbidity and patient characteristics on acute presentation with sore throat: a multicentre national audit.Annals of the Royal College of Surgeons of England · 2026Article
- Complexity, demand, and those little white spots.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Current Evidence and Gaps for Outpatient Respiratory Tract Infection Diagnostics: A Call to Action.Open forum infectious diseases · 2025Article
- Do Hospitalized Adult Patients with Acute Pharyngotonsillitis Need Empiric Antibiotics? The Impact on Antimicrobial Stewardship.Microorganisms · 2025Article
- Improving Antimicrobial Stewardship in Acute Sore Throat: Comparison of FeverPAIN and McIsaac Scores with Molecular Point of Care Testing Using Abbott ID NOW.Diagnostics (Basel, Switzerland) · 2024Article
- Explainable AI decision support improves accuracy during telehealth strep throat screening.Communications medicine · 2024Article
- Does the Addition of Point-of-Care Testing Alter Antibiotic Prescribing Decisions When Patients Present with Acute Sore Throat to Primary Care? A Prospective Test of Change.Diagnostics (Basel, Switzerland) · 2024Article
- Diagnosis of Epstein-Barr and cytomegalovirus infections using decision trees: an effective way to avoid antibiotic overuse in paediatric tonsillopharyngitis.BMC pediatrics · 2023Article
- Characteristics of the sore throat test and treat service in community pharmacies (STREP) in Wales: cross-sectional analysis of 11 304 consultations using anonymized electronic pharmacy records.The Journal of antimicrobial chemotherapy · 2022Article
- Streptococcal Pharyngitis Complicated by Clinically Significant Rheumatic Myopericarditis: A Case Report.Journal of investigative medicine high impact case reportsArticle
- Streptococcus A Rapid Diagnostic Testing in England Community Pharmacies: Clinical and Economic Impact of Empowering Pharmacists in Management of Sore Throat.Journal of primary care & community healthArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSore throat is a common and self-limiting condition. There remains ambiguity in stratifying patients to immediate, delayed, or no antibiotic prescriptions. The National Institute for Health and Care Excellence (NICE) recommends two clinical prediction rules (CPRs), FeverPAIN and Centor, to guide decision making.
aimTo describe the diagnostic accuracy of CPRs in identifying streptococcal throat infections. DESIGN &
settingAdults presenting to UK primary care with sore throat, who did not require immediate antibiotics.
methodAs part of the Treatment Options without Antibiotics for Sore Throat (TOAST) trial, 565 participants, aged ≥18 years, were recruited on day of presentation to general practice. Physicians could opt to give delayed prescriptions. CPR scores were not part of the trial protocol but were calculated post hoc from baseline assessments. Diagnostic accuracy was calculated by comparing scores with throat swab cultures.
resultsIt was found that 81/502 (16.1%) patients had group A, C, or G streptococcus cultured on throat swab. Overall diagnostic accuracy of both CPRs was poor: area under receiver operating characteristics (ROC) curve 0.62 for Centor; and 0.59 for FeverPAIN. Post-test probability of a positive or negative test was 27.3% (95% confidence interval [CI] = 6.0% to 61.0%) and 84.1% (95% CI = 80.6% to 87.2%) for FeverPAIN ≥4; versus 25.7% (95% CI = 16.2% to 37.2%) and 85.5% (95% CI = 81.8% to 88.7%) for Centor ≥3. Higher CPR scores were associated with increased delayed antibiotic prescriptions (χ
conclusionIn those who do not require immediate antibiotics in primary care, neither CPR provides a reliable way of diagnosing streptococcal throat infection. However, clinicians were more likely to give delayed prescriptions to those with higher scores.
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