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Published on: February 24, 2014
Evaluation of the WHO clinical decision rule for streptococcal pharyngitis
A W Rimoin1, H S Hamza, A Vince
1Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA. arimoin@ucla.edu
Insights
The World Health Organization clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS) pharyngitis shows high specificity but low sensitivity in identifying GABHS infections in children across three countries.
Area of Science:
- Pediatric infectious diseases
- Clinical diagnostics
- Public health
Background:
- Group A beta-hemolytic streptococcal (GABHS) pharyngitis is a common childhood illness.
- Accurate diagnosis of GABHS pharyngitis is crucial to prevent complications like rheumatic fever.
- The World Health Organization (WHO) developed a clinical decision rule (CDR) to aid diagnosis.
Purpose of the Study:
- To prospectively evaluate the diagnostic accuracy of the WHO CDR for GABHS pharyngitis.
- To assess the performance of the WHO CDR across different international settings.
Main Methods:
- Prospective, observational cohort study involving 2225 children aged 2-12 years in Brazil, Egypt, and Croatia.
- 1810 children with sore throat were analyzed for GABHS pharyngitis.
- WHO CDR performance was assessed for sensitivity and specificity.
Main Results:
- GABHS pharyngitis prevalence varied from 24.6% to 42.0% across study sites.
- The WHO CDR demonstrated high specificity (93.8-97.4%) but low sensitivity (0.0-10.8%) in all age groups and countries.
- The rule failed to identify a significant proportion of children with confirmed GABHS pharyngitis.
Conclusions:
- The current WHO CDR is not sufficiently sensitive for diagnosing GABHS pharyngitis in these populations.
- A revised CDR with improved sensitivity is needed, especially in regions with high burdens of rheumatic fever and rheumatic heart disease.
- Further research should focus on developing more sensitive diagnostic tools for GABHS infections.
Aims:
To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS) pharyngitis in three countries.
Methods:
A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2-12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis.
Results:
The proportion of children presenting with sore throat and found to have GABHS pharyngitis ranged from 24.6% (Brazil) to 42.0% (Croatia). WHO CDR sensitivity was low for all sites in both age groups. In children age 5 or older, sensitivity ranged from 3.8% in Egypt to 10.8% in Brazil. In children under 5, sensitivity was low (0.0-4.6%) Specificity was high in both age groups in all countries (93.8-97.4%).
Conclusions:
In these populations, the current WHO CDR has high specificity, but low sensitivity; it did not detect up to 96.0% of children who have laboratory confirmed GABHS pharyngitis. A CDR with higher sensitivity should be developed for use in regions where rheumatic fever and rheumatic heart disease are still major health problems.
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