Does This Patient Have Strep Throat?

摘要: ContextSore throat is a common complaint, and identifying patients with group A β-hemolytic streptococcal pharyngitis (strep throat) an important task for clinicians. Previous reviews have not systematically reviewed and synthesized the evidence.ObjectiveTo review precision accuracy of clinical examination in diagnosing strep throat.Data SourceMEDLINE search articles about diagnosis using history-taking and physical examination.Study SelectionLarge blinded, prospective studies (having ≥300 sore throat) reporting history data culture as reference standard were included. Of 917 identified by the search, 9 met all inclusion criteria.Data ExtractionPairs authors independently each article used consensus to resolve discrepancies.Data SynthesisThe most useful findings evaluating likelihood throat are presence tonsillar exudate, pharyngeal or exposure to strep throat infection in previous 2 weeks (positive ratios, 3.4, 2.1, 1.9, respectively) absence tender anterior cervical nodes, tonsillar enlargement, exudate (negative 0.60, 0.63, and 0.74, respectively). No individual element history-taking physical examination accurate enough itself rule out throat. Three validated prediction rules are described adult pediatric populations.ConclusionsWhile no single is sufficiently exclude diagnose throat, well-validated clinical can be help physicians make more informed use rapid antigen tests cultures.