FeverPAIN Score for Strep Pharyngitis
Why Use
Identifying the minority of pharyngitis patients with streptococcal infection can help providers reduce inappropriate antibiotic use in pharyngitis. The authors that derived the FeverPAIN Score performed an implementation study suggesting it can safely reduce antibiotic use by 30% ( Little 2014 ).
When to Use
Patients with pharyngitis in primary care settings.
Pearls / Pitfalls
The FeverPAIN Score for Strep Pharyngitis was developed to try and help assess which patients with pharyngitis have streptococcal infections. Developed in the setting of rapid antigen detection tests for multiple streptococcal strains (Group A, C, G). While it should be further validated, it appeared to have better utility than the Centor Criteria at lower levels to detect patients who could forgo antibiotic treatment ( Little 2014 ). Caution should be advised in using the FeverPAIN Score to determine need for treatment in patients that have worsening symptoms beyond 3 days. Beyond this point, the clinician must consider the possibility of a more serious or invasive infection. Should not be used in children <3 years old, as they are more likely to have viral infections and/or atypical presentations of streptococcal infection.
Critical Actions
The FeverPAIN Score requires close examination of the pharynx and precise history taking.
Advice
A low FeverPAIN Score suggests streptococcal infection is unlikely.
More Information
Score interpretation: A score of 0-1 is associated with 13-18% isolation of streptococcus (close to background carriage rates). No antibiotics recommended. A score of 2 is associated with 30-35% isolation of streptococcus. Delayed antibiotic may be appropriate. A score of 3 is associated with 39-48% isolation of streptococcus. Delayed antibiotic may be appropriate. A score of 4 or more is associated with 62-65% isolation of streptococcus. Consider antibiotics if symptoms are severe or a short delayed prescribing strategy may be appropriate (48 hours).