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Acute paediatrics
Evaluation of the WHO clinical decision rule for streptococcal pharyngitis
  1. A W Rimoin1,
  2. H S Hamza3,
  3. A Vince4,
  4. R Kumar5,
  5. C F Walker2,
  6. R A Chitale2,
  7. A L A da Cunha6,
  8. S Qazi7,
  9. M C Steinhoff2
  1. 1Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
  2. 2Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
  3. 3Department of Pediatrics, University of Cairo, Egypt
  4. 4University Infectious Disease Hospital, Zagreb, Croatia
  5. 5Department of Pediatrics, King George Medical College, Lucknow, India
  6. 6Department of Pediatrics, Federal University of Rio de Janeiro, Brazil
  7. 7Department of Child and Adolescent Health and Development, World Health Organisation, Geneva, Switzerland
  1. Correspondence to:
    Dr A W Rimoin
    Department of Epidemiology, UCLA School of Public Health, 71-279B CHS, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, USA; arimoinucla.edu

Abstract

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.

  • ARI, acute respiratory infection
  • CDR, clinical decision rule
  • GABHS, group A β haemolytic streptococcal
  • GNI, gross national income
  • NPV, negative predictive value
  • PPV, positive predictive value
  • RF, rheumatic fever
  • RHD, rheumatic heart disease
  • WHO, World Health Organisation
  • group A beta haemolytic streptococcal pharyngitis
  • GABHS
  • streptococcal pharyngitis
  • developing regions
  • clinical decision rule
  • diagnosis

https://doi.org/10.1136/adc.2004.069120

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    Footnotes

    • Funding: this study was supported by USAID. The Croatian site was funded by the Department of Child and Adolescent Health and Development, World Health Organisation

    • Competing interests: none

    • Published Online First 7 June 2005

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