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Strep Score

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1. Acute nasopharyngitis and acute strep throat in adults

Acute nasopharyngitis and acute strep throat in adults • an acute nasopharyngitis; • an acute strep throat with a McIsaac score 38° 1 Absence of cough 1 Painful anterior cervical adenopathy(s) 1 Increase in tonsillar volume or exudate 1 Age: • 15 to 44 years of age 0 • > 45 years of age -1 www.has-sante.fr 5 avenue du Stade de France - 93218 Saint-Denis La Plaine CEDEX Tel.: +33 (0) 1 55 93 70 00 - Fax: +33(0)1 55 93 74 00 © Haute Autorité de Santé - November 2016

2016 HAS Guidelines

2. Point-of-care diagnostic testing in primary care for strep A infection in sore throat

(strep A) throat infection. The inno innovativ vative aspects e aspects are the fast turnaround time compared with laboratory culture of throat swabs, allowing potential use in primary care. The intended use use would be in addition to clinical scoring systems, to increase diagnostic confidence of a suspected strep A infection and guide antibiotic prescribing for people presenting with sore throat in primary care and community pharmacies. The main points from the e main points from the evidence (...) vidence summarised in this briefing are from 4 prospective studies, 1 pilot study and 1 systematic review, including 102,694 patients, of whom 3,552 were tested with the technologies described in this briefing. The evidence, which covers 5 of 11 tests included in the briefing, suggests that point-of-care tests are more helpful for diagnosing strep A infection than clinical scoring systems alone in people with acute sore throat. K Ke ey uncertainties y uncertainties around the technology are the lack

2018 National Institute for Health and Clinical Excellence - Advice

3. Strep Score

Strep Score Strep Score Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Strep Score Strep Score Aka: Strep Score , Walsh Pharyngitis (...) Criteria , McIsaac Decision Rule , Modified Centor Criteria II. Indications Evaluation for III. Criteria: Modified Centor (recommended) lar exudate or erythema Anterior cervical adenopathy absent present Age Age 3 to 14 years: +1 point Age 15 to 45 years: 0 points Age over 45 years: -1 points IV. Approach: Clinical Suspicion based on scoring above Strep Score 4 to 5 (or Strep Score 2 if patient unreliable) Treat with antibiotics Strep Score 2 to 3: Perform rapid antigen test Antigen test positive

2018 FP Notebook

4. To rapid strep test or not to rapid strep test?

with an intermediate risk of strep pharyngitis should get a rapid strep test; point-of-care tools can help physicians quickly make that assessment. The authors assert that: Results from rapid antigen detection testing (RADT) should be used in conjunction with a validated clinical decision rule such as the modified Centor score or the FeverPAIN score. Patients at low risk of GABHS pharyngitis can be treated symptomatically, RADT should be ordered for those at intermediate risk, and empiric antibiotics are an option (...) of the time, it is most useful in patients with an intermediate of having strep pharyngitis. If you're clinically convinced that the patient does or does not have strep pharyngitis, this imperfect test shouldn't change your clinical management. The AFP article authors review the scoring systems most commonly used to assess the pre-test probability of strep pharyngitis, the Centor score and the modified Centor score. Both of these clinical decision rule scores are available in several point-of-care

2016 The AFP Community Blog

5. Signs and symptoms of Group A versus Non-Group A strep throat: A meta-analysis. (PubMed)

Signs and symptoms of Group A versus Non-Group A strep throat: A meta-analysis. Both non-Group A streptococcal (non-GAS) pharyngitis and Group A streptococcal (GAS) pharyngitis are commonly found in patients with sore throat. It is not known whether or not they present with similar signs and symptoms compared to patients with non-streptococcal pharyngitis.MEDLINE was searched for prospective studies that reported throat culture for both GAS and non-GAS as a reference standard, and reported (...) at least one sign, symptom, or the Centor score. Summary estimates of sensitivity, specificity, likelihood ratios (LR+ and LR-), and diagnostic odds ratios (DOR) were calculated using a bivariate random effects model. Summary receiver operating characteristic (ROC) curves were created for key signs and symptoms.Eight studies met our inclusion criteria. Tonsillar exudate had the highest LR+ for both GAS and non-GAS pharyngitis (1.53 versus 1.71). The confidence intervals of sensitivity, LR+, LR

2017 Family Practice

6. Why I oppose home strep testing

recommend not testing patients for group A strep unless they have a Centor score of 2 or greater. Currently many urgent care centers, emergency departments and retail clinics test everyone, regardless of the score. One would expect many to run a home test for any sore throat, therefore leading to continued over testing. Most experts believe that treating the zeros and ones means that we are giving antibiotics to carriers. The next false assumption is that the test is highly reliable. Our meta-analysis (...) Why I oppose home strep testing db's Medical Rants » Blog Archive » Why I oppose home strep testing Internal medicine, American health care, and especially medical education 1 Posted by rcentor | Posted on 20-09-2016 Category : Yesterday I read this tweet: home strep test likely to reduce inconvenience, cost, strep complications, unneeded antibiotic and antibiotic resistance #medx I disagree, but the reasons are fairly complex. In order to understand this problem, we have to define the possible

2016 db's Medical Rants blog

7. Tiny Tips: Modified Centor Score for Streptococcal Pharyngitis

responsible for uncomplicated acute pharyngitis are viral agents at 50-80% and Streptococcal agents, specifically Group A Beta-Hemolytic Strep, at 5-36%. 2 It is clinically significant to differentiate between these two pathogens as patients with the latter would benefit from antibiotic therapy, and patients with the former should not have antibiotic therapy due to deriving no benefit. Modified Centor Score Symptoms or Signs Points 1. History of Fever or measured temperature >38 o C +1 2. Absence of Cough (...) +1 3. Tender/Swollen anterior cervical lymphadenopathy +1 4. Tonsillar swelling or exudate +1 Age < 3-14 years* +1 Age 15 – 44 years 0 Age ≥ 45 years -1 Figure 1: McIssac Modification of the Centor Score. Data from group of 167 children >3 years and 453 adults in university-affiliated family medicine center in Toronto, ON Canada. The study and subsequent score excluded patients under 3 years of age as strep throat is very rare in this population. 3 The Modified Centor Score (also known

2017 CandiEM

8. Strep Score

Strep Score Strep Score Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Strep Score Strep Score Aka: Strep Score , Walsh Pharyngitis (...) Criteria , McIsaac Decision Rule , Modified Centor Criteria II. Indications Evaluation for III. Criteria: Modified Centor (recommended) lar exudate or erythema Anterior cervical adenopathy absent present Age Age 3 to 14 years: +1 point Age 15 to 45 years: 0 points Age over 45 years: -1 points IV. Approach: Clinical Suspicion based on scoring above Strep Score 4 to 5 (or Strep Score 2 if patient unreliable) Treat with antibiotics Strep Score 2 to 3: Perform rapid antigen test Antigen test positive

2015 FP Notebook

9. Effects of Oral Probiotic Supplementation on Group B Strep (GBS) Rectovaginal Colonization in Pregnancy

Effects of Oral Probiotic Supplementation on Group B Strep (GBS) Rectovaginal Colonization in Pregnancy Effects of Oral Probiotic Supplementation on Group B Strep (GBS) Rectovaginal Colonization in Pregnancy - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100 (...) ). Please remove one or more studies before adding more. Effects of Oral Probiotic Supplementation on Group B Strep (GBS) Rectovaginal Colonization in Pregnancy The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01479478 Recruitment Status : Completed First Posted : November 24, 2011 Results First Posted

2011 Clinical Trials

10. Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections. (PubMed)

at large abscess lesions was observed for Prevotella (P.) oralis, P. buccae, P. oris, P. intermedia, Fusobacterium nucleatum and Streptococcus (Strep.) anginosus group. An increased risk to occur at large infiltrate lesions was found for Strep. salivarius, Strep. parasanguis, Strep. anginosus group, Capnocytophaga spp., Neisseria (N.) sicca, Neisseria spp., Staphylococcus (Staph.) aureus, P. intermedia, P. buccae, Prevotella spp. and P. melaninogenica.The radiography-based score suggests that certain (...) Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections. To develop a new radiography-based score to assess the potential of bacteria to cause odontogenic infections derived from the occurrence of bacteria at small or large radiographical lesions.The patients analyzed were a sub-population from a large randomized clinical trial comparing moxifloxacin and clindamycin in the treatment of inflammatory infiltrates and odontogenic abscesses. Routine radiographs

2014 Acta odontologica Scandinavica

11. Peezy Midstream for urine collection

, however a small number highlighted that Peezy Midstream caused a mess and it was suggested that a glove or extra wipes could be included in the package. The most substantial negative aspect of the technology both in scores and comments, was the packaging and the integrated instructions. People highlighted that the bag would tear open unpredictably, causing the instructions to become unreadable or for contents to spill on the floor. Peezy Midstream for urine collection (MIB183) © NICE 2019. All rights (...) %) to 4/123 (3%), decreased the rate of faecal streps (enterococci) from 6/158 (4%) to 1/123 (1%), decreased the rate of mixed cultures from 20/158 (13%) to 8/123 (7%). Strengths and limitations Study published as a blog, so difficult to assess the quality of the study. Study done in the NHS so the results are generalisable. Abbreviations: eGFR, estimated glomerular filtration rate; EQUC, expanded quantitative urine culture; MSU, midstream urine. Recent and ongoing studies Watford General Hospital

2019 National Institute for Health and Clinical Excellence - Advice

12. What is the clinical and cost effectiveness of rapid antigen detection tests (RADTs) for Group A Streptococcal (GAS) infection in patients with acute sore throat in primary care?

no, immediate or delayed antibiotic prescribing, or use of RADT (IMI TestPack® Plus Strep A (Inverness Medical, Bedford, UK) targeted by high clinical score (=3) to guide antibiotic prescribing. The primary outcome was symptom control (severity and duration). Patient-reported rates of antibiotic use were also recorded. The trial was pragmatic in that, although clinicians were asked to use the intended strategy, there was flexibility in terms of what could be agreed with the patient. Intended strategy (...) Delayed antibiotics 21/207 (10%) 21/207 (10%) 164/207 (79%) 87/211 (41%) 33/211 (16%) 91/211 (43%) 126/213 (59%) 38/213 (18%) 48/213 (23%) Antibiotic use Antibiotic use risk ratio 75/164 (46%) 1 60/161 (37%) 0.71 (95% CI 0.50 to 0.95) p=0.018 58/164 (35%) 0.73 (95% CI 0.52 to 0.98) p=0.033 Another RCT 23 identified in the previously mentioned systematic review 21 compared antibiotic prescription, guided by a four item clinical score adapted from the Centor criteria plus RADT (Clearview ® Exact Strep

2018 Evidence Notes from Healthcare Improvement Scotland

14. The Collaborative Assessment, OTCA12, on “C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs)

diagnosis alone [5]. The authors subsequently used this threshold as part of a two-step clinical algorithm with approximately 30% of patients presenting with sore throat requir- ing a CRP measurement after clinical assessment [7]. The specificity of the algorithm was higher than the sensitivity (0.95 [0.88-1.00] versus 0.74 [0.53-0.88]). This two-step clinical algorithm re- quires further validation. At a threshold of 6 mg/L, CRP in combination with the Centor Score may be useful in ruling out GAS (...) pharyngitis (Centor Score 1-4: sensitivity: 0.90; specificity 0.45), but only if RADT is not available (Centor Score 1-4: sensitivity: 0.90; specificity 0.97) [6]. The low specificity of this cut-point means that many false positives may be treated unnecessarily with antibiotics. (D1005, D1006) Nine studies reported on the usefulness of CRP in LRTI and, or specifically in pneumonia. Five studies reported on the diagnostic accuracy of CRP at a specified threshold for diagnosing pneu- monia. Four studies

2019 EUnetHTA

15. Best Practices for Pain Management in Infants, Children, Adolescents, and Individuals with Special Health Care Needs

- able for assessing pain in verbal or nonverbal patients include: Faces Pain Scale (Revised), VAS, numeric rating scale, Faces, Legs, Activity, Cry, and Consolability score (FLACC), Revised Faces, Legs, Activity, Cry and Consolability (r-FLACC), and the McGill Pain Questionnaire. 19,21,22 Pain categories Pain may be divided into diagnostic categories such as soma- tic, visceral, and neuropathic. 23-26 Pain encountered in dentistry is typically inflammatory and categorized as somatic (i.e (...) or strep throat pain, and cold and cough. 88 The FDA warns that in the 12-17-year age group, these medications should not be used in high-risk patients (e.g., those with obesity, obstructive sleep apnea, lung tissue disease). 88 Further- more, tramadol and codeine should not be used if breastfeeding since active metabolites are present in breastmilk. 88 Opioids without active metabolites. Inactive metabolites refer to metabolites that do not have a noticeable effect on the CNS. Naturally-occurring

2018 American Academy of Pediatric Dentistry

18. Diagnosis and treatment of respiratory illness in children and adults.

for Group A Streptococcal (GAS) pharyngitis in patients with modified Centor criteria scores less than three or when viral features like rhinorrhea, cough, oral ulcers and/or hoarseness are present. Testing should generally be reserved for patients when there is a high suspicion for GAS and for whom there is intention to treat with antibiotics. This involves a shared decision-making conversation with patients and/or caregivers. Benefits : Judicious testing would reduce costs associated with over-testing (...) process is used in the development and revision of the Institute for Clinical Systems Improvement (ICSI) guidelines. Literature searches for this guideline were done in PubMed under following parameters: Time frame: May 2012–February 2017 for all topics except antibiotic use for strep pharyngitis and pharmacologic treatment for allergic and non-allergic rhinitis. The time frame for these two topics included January 2005–April 2017. Types of studies searched for: systematic reviews and meta-analyses

2017 National Guideline Clearinghouse (partial archive)

19. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention

, tonsillopharyngeal exudates, scarlatiniform rash, palatal petechiae, and swollen tonsils. Clinical scoring criteria have been developed to help determine the likelihood of a bacterial cause. The most widely used are the modified Centor criteria, which include fever by history, tonsillar exudates, tender anterior cervical adenopathy, and absence of cough ( ). Because the Centor criteria have a low positive predictive value for determining the presence of group A streptococcal infection, the IDSA suggests (...) technologies. Concern over patient satisfaction scores may limit the success of these interventions given that patient pressure plays a role in antibiotic overprescribing ( ). However, patient satisfaction depends more on the patient-centered quality of the encounter, such as the provider spending enough time with the patient to explain the patient's illness, than on the receipt of an antibiotic prescription ( ). To increase patient satisfaction and decrease antibiotic prescriptions for ARTI, we offer

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2016 American College of Physicians

20. Neonatal infection: antibiotics for prevention and treatment

and treatment strategies. The research should also consider the gestational age at which screening should occur. 4.2 Risk factors for early-onset neonatal infection and symptoms and signs Which risk factors for early-onset neonatal infection, clinical symptoms and signs of infection, and laboratory investigations should be used to identify babies who should receive antibiotics? Wh Why this is important y this is important The evidence reviewed for the guideline included several risk scoring models designed (...) ), or they did not examine predictive accuracy in independent training and validation sets. Further research is needed, particularly to examine risk scoring models that incorporate measurements from novel laboratory investigations, such as molecular diagnostics (polymerase chain reaction and 16S approaches). The ideal study design would be a randomised controlled trial that compares clinical outcomes associated with particular investigation and treatment initiation strategies. The next best design would

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

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