Centor score

Helps delineate management of a child or adult with potential Group A streptococcus (GAS).

Four parts to the Centor score exist, with each receiving one point.

1. Fever (greater than 100.4°F or 38°C)

2. Exudates or swelling of tonsils

3. Tender lymphadenopathy of anterior cervical nodes

4. Lack of cough

With a Centor score of 2 or 3 the patient should have cultures taken, and treatment only if results are positive.

With a Centor score of 4 or more patients should be treated empirically.

The Centor Criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in adult patients complaining of a sore throat.

A method to quickly diagnose the presence of Group A streptococcal infection or diagnosis of Streptococcal Pharyngitis in adult patients who presented to an urban emergency room complaining of a sore throat.

The patients are judged on four criteria, with one point added for each positive criterion:

History of fever

Tonsillar exudates

Tender anterior cervical adenopathy

Absence of cough

The Modified Centor Criteria add the patient’s age to the criteria

Age <15 add 1 point

Age >44 subtract 1 point

The point system is important in that it dictates management.

Scores may range from -1 to 5.

Guidelines for management state:

-1, 0 or 1 points – No antibiotic or throat culture necessary as risk of strep. infection is <10%)

2 or 3 points -Patients should receive a throat culture and treat with an antibiotic if culture is positive: Risk of strep. infection 32% if 3 criteria, 15% if 2

4 or 5 points – Treat empirically with an antibiotic with risk of strep. infection 56%

The presence of all four variables indicates a 40 – 60% positive predictive value for a culture of the throat to test positive for Group A Streptococcus bacteria.

The absence of all four variables indicates a negative predictive value of greater than 80%.

The high negative predictive value suggests that the Centor Criteria can be more effectively used for ruling out strep throat than for diagnosing strep throat.

The Centor criteria were originally developed for adults.

The Centor Criteria are ineffective in predicting the presence of Group A beta-haemolytic Streptococcus on throat swab cultures in children.

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