Screening and diagnosis

Classification and risk stratification

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Quality improvement

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Nonpharmacologic interventions

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Follow-up and surveillance

Specific circumstances

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Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The FeverPAIN score calculator is designed to estimate the probability of a streptococcal infection based on five specific clinical symptoms. The presence of each symptom contributes to a total score that reflects the likelihood of streptococcal pharyngitis.

Five questions guide the scoring:
- Did the patient have a fever in the past 24 hours?
- Is there an absence of cough or coryza?
- Did symptoms onset within the last 3 days?
- Are the tonsils purulent?
- Is there severe tonsil inflammation?

For each "yes" response, the calculator assigns one point. The sum of these points creates a FeverPAIN score, ranging from 0 to 5. This score is linked to a probability indicating the likelihood of having a streptococcal infection, with higher scores suggesting a higher risk.

Interpret the total score based on the associated risk percentages:
- A score of 0 corresponds to an 11% risk.
- A score of 1 indicates a 14% risk.
- A score of 2 suggests a 30% risk.
- A score of 3 suggests a 39% risk.
- Scores of 4 or more suggest a 62% risk.

This scoring system assists in determining whether further medical tests or treatments may be necessary, helping healthcare providers assess the need for intervention based on the quantified risk of infection.

The FeverPAIN score is a clinical calculator used for assessing the likelihood of streptococcal pharyngitis, commonly known as strep throat, in patients presenting with a sore throat. The acronym stands for Fever, Purulence (pus), Attend rapidly (within 3 days), severely Inflamed tonsils, and No cough or coryza (cold symptoms). Each of these criteria is given a score of 0 or 1, and the total score is used to estimate the probability of a streptococcal infection.

This calculator is applicable to patients of all ages who present with symptoms of a sore throat. The clinical utility of the FeverPAIN score is to guide clinicians in deciding whether to prescribe antibiotics for a sore throat, as antibiotics are only beneficial in cases of streptococcal pharyngitis. 

There are no specific exclusion criteria for the use of the FeverPAIN score. However, it should be noted that this score does not replace clinical judgment and should be used in conjunction with a thorough clinical assessment. It may not be as accurate in patients with recurrent episodes of strep throat or in those who have recently taken antibiotics.

FeverPAIN score for streptococcal pharyngitis

The Modified Centor Score is a tool used to evaluate the likelihood of streptococcal throat infection, guiding decisions on testing and treatment. It considers five clinical factors, assigning a score to each based on predefined criteria. 

To calculate the score, input the following details for a patient:

1. **Age:**
   - 3-14 years: Score 1
   - 15-44 years: Score 0
   - 45 years or older: Score 1

2. **Tonsillar exudate or swelling:**
   - Yes: Score 1
   - No: Score 0

3. **Tender or swollen anterior cervical lymph nodes:**
   - Yes: Score 1
   - No: Score 0

4. **Temperature greater than 38°C (100.4°F):**
   - Yes: Score 1
   - No: Score 0

5. **Presence of cough:**
   - Yes: Score 0
   - No: Score 1

Add up the scores from these categories to get a total score between 0 and 5.

Interpret the total score to determine the appropriate clinical action:

- **0 points:** An estimated 1-2.5% risk of streptococcal infection; no further testing or antibiotics are necessary.
- **1 point:** A risk of 5-10%; again, no need for further testing or antibiotics.
- **2 points:** Risk rises to 11-17%; consider conducting a rapid test or throat culture.
- **3 points:** The risk increases to 28-35%; rapid test or culture should be considered.
- **4 or more points:** Significant risk of 51-53%; empiric antibiotics and/or rapid testing or culture are recommended.

This scoring method helps in assessing streptococcal infection risk and aids in clinical decision-making regarding testing and treatment.

The Modified Centor Score, also known as the McIsaac Score, is a clinical decision tool used in the assessment of patients presenting with sore throat. It is specifically designed to predict the likelihood of Group A Streptococcus (GAS) pharyngitis, a common cause of throat infection. 

The score is applicable to both pediatric and adult populations, but it is particularly useful in primary care settings where rapid strep testing may not be readily available. The Modified Centor Score helps clinicians decide whether to treat a sore throat with antibiotics or not, based on the probability of a streptococcal infection. 

The score takes into account five factors: patient's age, presence of fever, absence of cough, swollen and tender cervical lymph nodes, and tonsillar swelling or exudate. Each factor contributes to the total score, which ranges from -1 to 5. 

There are no specific exclusion criteria for the use of the Modified Centor Score, but it should be noted that it is not designed to predict other causes of pharyngitis, and should not replace clinical judgment. It is also less accurate in populations where the prevalence of GAS pharyngitis is very low or very high.

PFAPA syndrome

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Key sources