Clinical score effective in treating sore throat

Image: PD/CDC

1. A clinical score was found to help target antibiotic use for sore throat, and resulted in improved symptom management and reduced antibiotic usage when compared to control measures (delayed antibiotic prescribing). 

Evidence Rating Level: 2 (Good)

Study Rundown: Primary care providers often use rapid antigen tests and clinical scores to diagnose and treat streptococcal infection. This research examines the comparative effectiveness of these methods in managing the symptoms and duration of illness, compared to delayed antibiotic prescribing. From 2008-2011, participating general practitioners recruited 631 patients and randomly assigned them to control (delayed prescribing), clinical score, and rapid antigen detection test groups.

Researchers found that in both the clinical score and rapid antigen test groups, symptom severity was improved by roughly 33% and 30%, respectively (p<.05 for both). Furthermore, symptom duration was found to be one day shorter within the clinical score group. Use of antibiotics was also significantly lower in both the clinical score and rapid antigen test groups. Researchers concluded that given the relative equity in symptom improvement and the shorter duration of symptoms, the clinical score method was most effective in diagnosing and treating sore throat. The sample size included in the study is rather small and the subjectivity of Likert scales in evaluating symptom severity should also be considered in interpreting the data.

Click to read the study in BMJ

Relevant Reading: Antibiotics for sore throat

In-Depth [randomized controlled trial]: 207 subjects were assigned to the control (delayed prescribing) group, 211 in the clinical score group and 213 in the rapid antigen detection test group. Specifically, the control treatment protocol was a delayed antibiotic prescription, wherein clinicians advised patients to return and fill the prescription if symptoms persisted after three to five days. For the test groups, the FeverPAIN clinical score and IMI rapid antigen detection test were used as the diagnostic techniques for the respective groups.

A Likert scale assessed each group’s symptom severity and the results found that using the clinical score  and rapid antigen test significantly improved the severity of symptoms (p<.05 for both groups). Additionally, moderate symptoms in the clinical score group were found to resolve one day earlier compared to the other two groups (hazard ratio 1.30, 95% CI: 1.03 to 1.63; P=0.03). Use of antibiotics was 29% lower in the clinical score group and 27 % lower in the antigen test group, when compared to the control group (p<.05 for both, overall use in control group of 46%).

By Jordan Anderson and Andrew Bishara

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