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Participatory Medicine: A Home Score for Streptococcal Pharyngitis Enabled by Real-Time Biosurveillance: A Cohort Study

Andrew M. Fine, MD, MPH; Victor Nizet, MD; and Kenneth D. Mandl, MD, MPH
[+] Article, Author, and Disclosure Information

From Boston Children's Hospital, Harvard Medical School, Harvard-MIT Health Sciences and Technology, and the Center for Biomedical Informatics, Boston, Massachusetts, and the Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California.

Note: Dr. Fine had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Grant Support: By the Mentored Public Health Research Scientist Development Award K01HK000055 and Public Health Informatics Center of Excellence Award P01HK000088 from the Centers for Disease Control and Prevention and by 1G08LM009778 and R01 LM007677 from the National Library of Medicine, National Institutes of Health.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0067.

Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Available from Dr. Fine (e-mail, andrew.fine@childrens.harvard.edu).

Requests for Single Reprints: Andrew M. Fine, MD, MPH, Division of Emergency Medicine-Main 1, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115; e-mail, andrew.fine@childrens.harvard.edu.

Current Author Addresses: Dr. Fine: Division of Emergency Medicine-Main 1, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.

Dr. Nizet: Division of Pediatric Pharmacology and Drug Discovery, University of California, San Diego, School of Medicine, Cellular & Molecular Medicine East, Room 1066, 9500 Gilman Drive, Mail Code 0687, La Jolla, CA 92093-5611.

Dr. Mandl: Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.

Author Contributions: Conception and design: A.M. Fine, K.D. Mandl.

Analysis and interpretation of the data: A.M. Fine, V. Nizet, K.D. Mandl.

Drafting of the article: A.M. Fine, K.D. Mandl.

Critical revision of the article for important intellectual content: A.M. Fine, V. Nizet, K.D. Mandl.

Final approval of the article: A.M. Fine, V. Nizet, K.D. Mandl.

Provision of study materials or patients: A.M. Fine.

Statistical expertise: A.M. Fine.

Obtaining of funding: A.M. Fine, K.D. Mandl.

Administrative, technical, or logistic support: A.M. Fine, K.D. Mandl.

Collection and assembly of data: A.M. Fine, K.D. Mandl.

Ann Intern Med. 2013;159(9):577-583. doi:10.7326/0003-4819-159-9-201311050-00003
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Chinese translation

Background: Consensus guidelines recommend against testing or treating adults at low risk for group A streptococcal (GAS) pharyngitis.

Objective: To help patients decide when to visit a clinician for the evaluation of sore throat.

Design: Retrospective cohort study.

Setting: A national chain of retail health clinics.

Patients: 71 776 patients aged 15 years or older with pharyngitis who visited a clinic from September 2006 to December 2008.

Measurements: The authors created a score using information from patient-reported clinical variables plus the incidence of local disease and compared it with the Centor score and other traditional scores that require clinician-elicited signs.

Results: If patients aged 15 years or older with sore throat did not visit a clinician when the new score estimated the likelihood of GAS pharyngitis to be less than 10% instead of having clinicians manage their symptoms following guidelines that use the Centor score, 230 000 visits would be avoided in the United States each year and 8500 patients with GAS pharyngitis who would have received antibiotics would not be treated with them.

Limitation: Real-time information about the local incidence of GAS pharyngitis, which is necessary to calculate the new score, is not currently available.

Conclusion: A patient-driven approach to pharyngitis diagnosis that uses this new score could save hundreds of thousands of visits annually by identifying patients at home who are unlikely to require testing or treatment.

Primary Funding Source: Centers for Disease Control and Prevention and the National Library of Medicine, National Institutes of Health.




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Summary for Patients

A Home Score for Streptococcal Pharyngitis

The full report is titled “Participatory Medicine: A Home Score for Streptococcal Pharyn-gitis Enabled by Real-Time Biosurveillance. A Cohort Study.” It is in the 5 November 2013 issue of Annals of Internal Medicine (volume 159, pages 577-583). The authors are A.M. Fine, V. Nizet, and K.D. Mandl.


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