Centor criteria
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The Centor criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in patients complaining of a sore throat. They were developed as a method to quickly diagnose the presence of Group A streptococcal infection or diagnosis of streptococcal pharyngitis in "adult patients who presented to an urban emergency room complaining of a sore throat."[1] The Centor criteria are named after Robert M. Centor, an internist at the University of Alabama at Birmingham School of Medicine.
Criteria
[edit]The patients are judged on four criteria, with one point added for each positive criterion:[1]
- Absence of cough
- Tonsillar exudates (ooze)
- History of fever
- Tender anterior cervical adenopathy
The modified Centor criteria also incorporate the patient's age:[2]
- Age under 15 add 1 point
- Age over 44 subtract 1 point
Mnemonic using criteria name
[edit]A mnemonic to remember Centor is:[citation needed]
- C – Cough absent, or the incorrect but memorable "Can't Cough"
- E – Exudate
- N – Nodes
- T – temperature (fever)
- OR – young OR old modifier
Scoring
[edit]The point system is important in that it dictates management.
Scores may range from −1 to 5.
Guidelines for management state:[1]
- -1, 0 or 1 point(s) – No antibiotic or throat culture necessary (risk of strep. infection <10%)
- 2 or 3 points – Should receive a throat culture and treat with an antibiotic if culture is positive (risk of strep. infection 32% if 3 criteria, 15% if 2)
- 4 or 5 points – Consider rapid strep testing and or culture. (Risk of strep. infection 56%) – Infectious Diseases Society of America and American College of Physicians no longer recommend empiric treatment for strep based on symptomatology alone.
In the UK there is not a differentiator for age, and score ranges from 0 to 4, with 3–4 being offered treatment and no indication for swabs.[citation needed]
The presence of all four variables indicates a 40–60% positive predictive value for a culture of the throat to test positive for Group A streptococcus bacteria. The absence of all four variables indicates a negative predictive value of greater than 80%.[3] The high negative predictive value suggests that the Centor criteria can be more effectively used for ruling out strep throat than for diagnosing strep throat.[citation needed]
The Centor criteria were originally developed for adults. A study published in the British Medical Journal in 2013 looked at whether it could be applied to children aged 2–16. It was a retrospective study (2008–2010) and looked at 441 children who attended a Belgian hospital emergency department and had a throat swab taken. It concluded that the Centor criteria are ineffective in predicting the presence of Group A beta-haemolytic streptococcus (i.e. antibiotic treatment-worthy) on throat swab cultures in children.[4]
References
[edit]- ^ a b c Centor RM; Witherspoon JM; Dalton HP; Brody CE; Link K (1981). "The diagnosis of strep throat in adults in the emergency room". Medical Decision Making. 1 (3): 239–246. doi:10.1177/0272989x8100100304. PMID 6763125. S2CID 23535783.
- ^ McIsaac WJ; Kellner JD; Aufricht P; Vanjaka A; Low DE (7 April 2004). "Empirical Validation of Guidelines for the Management of Pharyngitis in Children and Adults". Journal of the American Medical Association. 291 (13): 1587–1595. doi:10.1001/jama.291.13.1587. PMID 15069046.
- ^ Marín Cañada J, Cubillo Serna A, Gómez-Escalonilla Cruz N, Garzón de la Iglesia J, Benito Ortiz L, Reyes Fernández MN (July 2007). "Is streptococcal pharyngitis diagnosis possible?". Atencion Primaria (in Spanish). 39 (7): 361–365. doi:10.1157/13107724. PMC 7664574. PMID 17669320.
- ^ Roggen, I; G. van Berlaer; F. Gordts; I. Hubloue (22 April 2013). "Centor Criteria, For what it's worth". BMJ Open. 3 (4): e002712. doi:10.1136/bmjopen-2013-002712. PMC 3641432. PMID 23613571.
- Chan TV (September 2010). "The Patient with Sore Throat". Medical Clinics of North America. 94 (5): 923–943. doi:10.1016/j.mcna.2010.06.001. PMC 7094485. PMID 20736104.