Research
The usefulness of a clinical 'scorecard' in managing patients with sore throat in general practice
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* Corresponding author: Tony MO Bakare tonybjoy@yahoo.com.au
Department of General Practice, School of Primary Health Care, Bldg 1, 270 Ferntree Gully Rd, Notting Hill, Melbourne, Victoria 3168, Australia
Asia Pacific Family Medicine 2010, 9:9 doi:10.1186/1447-056X-9-9
Published: 29 July 2010Abstract
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.