NICE CKS Guidelines for the Management of an Acute Sore Throat Flashcards
how do you To identify the underlying cause of a sore throat
Examine the person’s throat and neck:
Pharyngitis is often is associated with pharyngeal exudate and cervical lymphadenopathy
Tonsillitis is associated with tonsillar exudate and enlargement and erythema of the tonsils. There may be anterior cervical lymphadenopathy.
Ask the person about their symptoms. Non-specific symptoms may include:
Headache, nausea, vomiting, and abdominal pain — may be present in children with pharyngitis, and all people with tonsillitis.
Fever — this is common in pharyngitis and tonsillitis.
Most people with acute tonsillitis have a fever >38°C.
Be aware that a sore throat may occasionally result in significantly reduced fluid intake, which may lead to dehydration:
Ask the person about recent fluid intake if pain on swallowing is significant. For babies and young children, ask the parent/carer about number of wet nappies, whether fluid intake is significantly reduced (50 to 75% normal volume) and examine the child for signs of clinical dehydration (reduced skin turgor and/or a capillary refill time of more than three seconds, and/or dry mucous membranes).
Consider the person’s signs and symptoms, and use the FeverPAIN or Centor clinical prediction score to determine the likelihood of streptococcal infection (and therefore the need for antibiotic treatment):
Acute Group A streptococcal (GAS) pharyngitis/tonsillitis is common in children and adolescents aged 5 to 15 years and is more common in the winter (or early spring) in temperate climates. Streptococcal infection is suggested by fever > 38.5°C, exudate on the pharynx/tonsils, anterior neck lymphadenopathy, and absence of cough. A scarlatiniform rash may be present, especially in children.
The FeverPAIN criteria are:
The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
A score of 0 or 1 is associated with a 13% to 18% likelihood of isolating streptococcus. A score of 2 or 3 is associated with a 34% to 40% likelihood of isolating streptococcus. A score of 4 or 5 is associated with a 62% to 65% likelihood of isolating streptococcus.
