McIsaac criteria for diagnosis of acute group-A β-hemolytic streptococcal pharyngitis
Keywords:
diagnostic testing, pharyngitis, group-A β-hemolytic streptococcus (GABHS), McIsaac
Abstract
Background The early use of antibiotics for acute upper respiratory infections is controversial because most of these infections are caused by viruses. A strategy is needed to correctly identify the causitive agents of acute pharyngitis, so that antibiotics can be prescribed appropriately.Objective To assess McIsaac criteria for diagnosing acute group-A β-hemolytic streptococcal (GABHS) pharyngitis in children.
Methods This diagnostic study was conducted from August 2011 to February 2012, to compare clinical criteria of McIsaac to throat swab culture results as the gold standard for diagnosis. Subjects were children aged 3-14 years who visited the pediatric outpatient clinic or emergency ward at Sanglah Hospital and the pediatric outpatient clinic at Wangaya Hospital.
Results There were 550 cases of acute pharyngitis during the study period, with 313 patients aged 3-14 years and 199 patients excluded due to a history of taking antibiotics in the two weeks prior to the hospital visit. Hence, 114 subjects were eligible for the study. GABHS prevalence in this study was 7.9%. McIsaac’s area under the curve (AUC) from receiver operating characteristic (ROC) curve was 78.1%(95%CI 60.3 to 96%, P= 0.005). A McIsaac score ≥4 had a 66.7% (95%CI 49 to 97%) sensitivity, 87.6% (95% CI 81 to 94%) specificity, 31.6% (95 %CI 11 to 52%) positive predictive value (PPV), 96.8% (95%CI 93 to 100%) negative predictive value (NPV), 86.0% accuracy, 5.4 (95% CI 2.7 to 10.7) positive likelihood ratio (LR+) and 0.4 (95% CI 0.2 to 0.9) negative likelihood ratio (LR-).
Conclusion A McIsaac criteria total score of <4 is favorable for excluding a diagnosis of GABHS pharyngitis. A McIsaac total criteria score of ≥4 requires further examination to confirm a diagnosis of GABHS pharyngitis.
References
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16. Gitawati R, IsnawatiA.Pola sensitivitas kuman dari isolat hasil usap tenggorok penderita tonsilofaringitis akut terhadap beberapa antimikroba betalaktam di Puskesmas Jakarta Pusat. Cermin Dunia Kedokteran. 2009;144:20-3.
17. Ross PW, Chisty SM, Knox JD. Sore throat in children: its causation and incidence. Br Med J. 1971;2:624-6.
2. Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults, reliability of rapid streptococcal tests and clinical findings. Arch Intern Med. 2006;166:640-4.
3. Hadi U, Duerink DO, Lestari ES, Nagelkerke NJ, Keuter M,Huis In’t veld D, et al. Audit of antibiotic prescibing in two governmental teaching hospitals in Indonesia. Clin Microbiol Infect. 2008;14:698-707.
4. Chazan B, Shaabi M, Bishara E, Colodner R, Raz R. Clinical predictors of streptococcal pharyngitis in adults. Isr Med Assoc J. 2003;5:413-5.
5. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998;158:75-83.
6. Pusponegoro HD. Uji diagnostik. In: Sastroasmoro S, Ismael S, editor. Dasar-dasar metodologi penelitian klinis. 3rd ed. Jakarta:CV. Sagung Seto; 2010. p.193-216.
7. Jurianti A. Faringitis grup-A β-hemolitik streptokokus
pada anak-anak: klinis dan kultur usap tenggorok [master’s thesis]. Yogyakarta: Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Gajah Mada; 2008.
8. McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004;291:1587-95.
9. Lindbaek M, Hoiby EA, Lermark G, Steinsholt IM, Hjortdahl P.Clinical symptoms and signs in sore throat patients with large colony variant β-haemolytic streptococci groups C or G versus group A. Br J Gen Pract. 2005;55:615-9.
10. Steinhoff MC, Rimoin AW.Epidemiology, clinical presentations, and diagnosis of streptococcal pharyngitis in developing countries of the world. In: Pachere JC, Kaplan EL, editors. Streptococcal pharyngitis optimal management. 3rd ed. Basel: Karger; 2004. p.49-65.
11. Jain A, Shukla VK, Tiwari V, Kumar R.Antibiotic resistance pattern of group-A beta hemolytic streptococci isolated from north Indian children. Indian J Med Sci. 2008;62:392-6.
12. Tanz RR, Shulman ST. Sore throat. In: KliegmanRM, Green Baum LA, LyePS, editors. Practical strategies in pediatric diagnosis and therapy. 2nd ed. Philadelphia: Elsevier Saunders; 2004. p.3-15.
13. Dahlan MS. Analisis penelitian diagnostik. In: Seri evidence-based medicine 5: penelitian diagnostik. 1st ed. Jakarta: Salemba Medika; 2009. p. 19-30.
14. Dahlan MS. Memperoleh nilai area under the curve dengan prosedur receiver operating characteristic. In: Seri evidence-based medicine 5: penelitian diagnostik. 1st ed. Jakarta: Salemba Medika; 2009. p.55-60.
15. Dahlan MS. Menentukan titik potong dengan prosedur receiver operating characteristic. In: Seri evidence-based medicine 5: penelitian diagnostik. 1st ed. Jakarta: Salemba Medika; 2009. p.61-74.
16. Gitawati R, IsnawatiA.Pola sensitivitas kuman dari isolat hasil usap tenggorok penderita tonsilofaringitis akut terhadap beberapa antimikroba betalaktam di Puskesmas Jakarta Pusat. Cermin Dunia Kedokteran. 2009;144:20-3.
17. Ross PW, Chisty SM, Knox JD. Sore throat in children: its causation and incidence. Br Med J. 1971;2:624-6.
Published
2013-10-30
How to Cite
1.
Malino I, Utama D, Soenarto Y. McIsaac criteria for diagnosis of acute group-A β-hemolytic streptococcal pharyngitis. PI [Internet]. 30Oct.2013 [cited 29Apr.2024];53(5):258-3. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/302
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Received 2016-08-21
Accepted 2016-08-21
Published 2013-10-30
Accepted 2016-08-21
Published 2013-10-30
