FeverPAIN vs the Centor Score

On twitter this week, several British tweeters discussed whether they should use the FeverPAIN score or the Centor score.  Obviously I have a bias here, but I will try to discuss this issue dispassionately. So I downloaded the PRISM study, where the authors proposed FeverPAIN.  The goal of FeverPAIN is to increase the patient cohort not needing testing or antibiotics.  As I studied FeverPAIN I found one important advance, but another point of naïveté. To frame the discussion, the FeverPAIN study took all patients >3 years with sore throats.  They used positive testing for group A, C or G beta hemolytic streptococci as their dichotomous outcome.  They developed a 5 point scale (1 point of each): Fever in past 24 hours Absence of cough or coryza Symptom onset with 3 days Purulent tonsils Severe tonsil inflammation Contrast this with the Centor score (again 1 point each): Fever history Tonsillar exudates Swollen, tender anterior cervical nodes No cough My first quick impression is that the 2 scores are measuring the same concepts.  Bacterial infections – both group A and group C/G streptococci and (in our recent study) Fusobacterium necrophorum cause an inflammatory response (exudates, swelling, adenopathy), a fever response and a lack of a viral response (lack of cough or coryza).  Thus the two scores will have a very high correlation when you study the components. FeverPAIN includes an interesting variable – symptom onset at 3 ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs