Sore Throat
Acute sore throat is a common clinical presentation across primary and secondary care and is commonly caused by viral and bacterial aetiologies (amongst others). The Centor9 and McIsaac10 scores are both recommended by NICE to diagnose group A beta-haemolytic streptococcus (GABHS) infection11, which are more likely to require antibiotic therapy. The Centor score and McIsaac score were developed independently, but the McIsaac score adds age to the decision rule.
McIsaac Centor Criteria
| Criteria | Points |
| Age 3-14 Age 15-44 Age 45 | 1 0 -1 |
| Tonsillar swelling or exudate | 1 |
| Tender/ swollen anterior Cervical Lymph nodes | 1 |
| Fever (temperature >38OC) | 1 |
| Absence of cough | 1 |
Each of the McIsaac Centor criteria score 1 point (with a maximum score of 4). A score of 0, 1 or 2 is thought to be associated with a 3- 17% likelihood of isolating streptococcus. A score of 3 or 4 is thought to be associated with a 32-56% likelihood of isolating streptococcus.
FeverPAIN12
| Fever last 24Hrs | 1 |
| Pus on Tonsils | 1 |
| Attend rapidly (3 or less days) | 1 |
| Severely Inflamed tonsils | 1 |
| No cough or coryza (i.e. Pharyngeal Illness) | 1 |
Each of the FeverPAIN criteria score 1 point (for a maximum score of 5). Higher scores suggest more severe symptoms and a greater likelihood of a bacterial (streptococcal) cause. A score of 0 or 1 is thought to be associated with a 1318% likelihood of isolating streptococcus, 2 or 3 a 3440% likelihood of isolating streptococcus, and 4 or 5 a 6265% likelihood of isolating streptococcus.13
A metanalysis performed in 202013 comparing Centor and FeverPAIN in primary care setting found ten studies using the Centor score and eight using the McIsaac score. This study found the two scores equivalent with the areas under the ROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The p-value for difference was 0.419, suggesting they were equivalent. Both scores demonstrated poor calibration, suggesting other point-of-care tests are required to rule in GABHS. However, a score of 0 may be sufficient to rule out infection in either score.13
A recent retrospective Cohort study in the EMJ14 compared the usage of the score against actual clinical practice in the paediatric population. It found that current NICE guidance is variably interpreted and inconsistently implemented in paediatric populations. FeverPAIN and Centor scoring systems may not rationalise antibiotics as much as previously reported compared with judicious clinician practice. It concluded that producing clear paediatric-specific national guidelines, especially for the under-5s omitted from NICE sore throat guidance, may help further rationalise and standardise antibiotic use in paediatric tonsillopharyngitis.