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: rcentor Tags: Medical Rants Source Type: blogs
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