Research

The usefulness of a clinical 'scorecard' in managing patients with sore throat in general practice

Tony MO Bakare and Peter Schattner

Department of General Practice, School of Primary Health Care, Bldg 1, 270 Ferntree Gully Rd, Notting Hill, Melbourne, Victoria 3168, Australia

author email corresponding author email

Asia Pacific Family Medicine 2010, 9:9doi:10.1186/1447-056X-9-9

Published:	29 July 2010

Abstract

Background

Objective: To evaluate the usefulness of a clinical scorecard in managing sore throat in general practice.

Design: Validation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'.

Setting: A solo family practice in rural New South Wales, Australia

Participants: Patients attending with sore throat.

Methods

Patients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (> 16 yrs) were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5 yr to < 16 yrs old) were asked to complete a similar, guardian questionnaire.

Main outcome measures:

1. Ability of a new scorecard to differentiate between bacterial and non-bacterial sore throat.

2. Patients' trust in the scorecard.

Results

The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity.

There was a high level of patient trust in the scorecard was (85.8% agreement). Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement).

Conclusions

As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection.