Abstract：
BACKGROUND: Centor and McIsaac scores are clinical prediction rules for diagnosing group A streptococcus (GAS) infection in patients with pharyngitis. Their recommended thresholds vary between guidelines.
OBJECTIVE: To estimate the sensitivity and specificity of the McIsaac and Centor scores to diagnose GAS pharyngitis and evaluate their impact on antibiotic prescribing at each threshold in patients presenting to secondary care.
METHODS: MEDLINE, Embase, and Web of Science were searched from inception to September 2022.
METHODS: Studies of patients presenting with acute pharyngitis to emergency or outpatient clinics that estimated the accuracy of McIsaac or Centor scores against throat cultures and/or rapid antigen detection tests (RADT) as reference standards.
METHODS: Centor or McIsaac score.
UNASSIGNED: Throat cultures and/or RADT.
UNASSIGNED: Quality Assessment of Diagnostic Accuracy Studies.
UNASSIGNED: The sensitivities and specificities of the McIsaac and Centor scores were pooled at each threshold using bivariate random effects meta-analysis.
RESULTS: Fourteen studies were included (eight McIsaac and six Centor scores). Eight studies had unclear and six had a high risk of bias. The McIsaac score had higher estimated sensitivity and lower specificity relative to Centor scores at equivalent thresholds but with wide and overlapping confidence regions. Using either score as a triage to RADT to decide antibiotic treatment would reduce antibiotic prescription to patients with non-GAS pharyngitis relative to RADT test for everyone, but also reduce antibiotic prescription to patients with GAS.
CONCLUSIONS: Centor and McIsaac scores are equally ineffective at triaging patients who need antibiotics presenting with pharyngitis at hospitals. At high thresholds, too many true positive cases are missed, whereas at low thresholds, too many false positives are treated, leading to the over prescription of antibiotics. The former may be compensated by adequate safety netting by clinicians, ensuring that patients can seek help if symptoms worsen.
OBJECTIVE: To estimate the sensitivity and specificity of the McIsaac and Centor scores to diagnose GAS pharyngitis and evaluate their impact on antibiotic prescribing at each threshold in patients presenting to secondary care.
METHODS: MEDLINE, Embase, and Web of Science were searched from inception to September 2022.
METHODS: Studies of patients presenting with acute pharyngitis to emergency or outpatient clinics that estimated the accuracy of McIsaac or Centor scores against throat cultures and/or rapid antigen detection tests (RADT) as reference standards.
METHODS: Centor or McIsaac score.
UNASSIGNED: Throat cultures and/or RADT.
UNASSIGNED: Quality Assessment of Diagnostic Accuracy Studies.
UNASSIGNED: The sensitivities and specificities of the McIsaac and Centor scores were pooled at each threshold using bivariate random effects meta-analysis.
RESULTS: Fourteen studies were included (eight McIsaac and six Centor scores). Eight studies had unclear and six had a high risk of bias. The McIsaac score had higher estimated sensitivity and lower specificity relative to Centor scores at equivalent thresholds but with wide and overlapping confidence regions. Using either score as a triage to RADT to decide antibiotic treatment would reduce antibiotic prescription to patients with non-GAS pharyngitis relative to RADT test for everyone, but also reduce antibiotic prescription to patients with GAS.
CONCLUSIONS: Centor and McIsaac scores are equally ineffective at triaging patients who need antibiotics presenting with pharyngitis at hospitals. At high thresholds, too many true positive cases are missed, whereas at low thresholds, too many false positives are treated, leading to the over prescription of antibiotics. The former may be compensated by adequate safety netting by clinicians, ensuring that patients can seek help if symptoms worsen.
摘要：
背景：Centor和McIsaac评分是诊断咽炎患者A组链球菌（GAS）感染的临床预测规则。它们的建议阈值因指南而异。
目的：评估McIsaac和Centor评分诊断GAS咽炎的敏感性和特异性，并评估其对接受二级护理的患者在每个阈值下抗生素处方的影响。
方法：MEDLINE，Embase和WebofScience从成立到2022年9月进行了搜索。
方法：对急诊或门诊就诊的急性咽炎患者进行的研究评估了McIsaac或Centor评分与咽喉培养和/或快速抗原检测试验（RADT）作为参考标准的准确性。
方法：Centor或McIsaac评分参考标准：咽部培养和/或RADT偏差风险评估：QUADAS-2方法：数据综合：使用双变量随机效应荟萃分析，在每个阈值处汇总McIsaac和Centor评分的敏感性和特异性。
结果：纳入14项研究（8McIsaac和6Centor评分）。8项研究不清楚，6项研究有很高的偏倚风险。相对于同等阈值的Centor评分，McIsaac评分具有更高的估计灵敏度和更低的特异性。但是具有广泛和重叠的信任区域。相对于每个人的RADT测试，使用任一评分作为RADT的分类来决定抗生素治疗将减少非GAS咽炎患者的抗生素处方，而且还减少了对GAS患者的抗生素处方。
结论：Centor和McIsaac评分对于在医院出现咽炎需要抗生素的患者分类同样无效。在高门槛下，错过了太多真正的阳性病例，在低门槛时，太多的假阳性被治疗，导致抗生素的过度处方。前者可以通过临床医生提供足够的安全网来补偿，确保患者在症状恶化时可以寻求帮助。
目的：评估McIsaac和Centor评分诊断GAS咽炎的敏感性和特异性，并评估其对接受二级护理的患者在每个阈值下抗生素处方的影响。
方法：MEDLINE，Embase和WebofScience从成立到2022年9月进行了搜索。
方法：对急诊或门诊就诊的急性咽炎患者进行的研究评估了McIsaac或Centor评分与咽喉培养和/或快速抗原检测试验（RADT）作为参考标准的准确性。
方法：Centor或McIsaac评分参考标准：咽部培养和/或RADT偏差风险评估：QUADAS-2方法：数据综合：使用双变量随机效应荟萃分析，在每个阈值处汇总McIsaac和Centor评分的敏感性和特异性。
结果：纳入14项研究（8McIsaac和6Centor评分）。8项研究不清楚，6项研究有很高的偏倚风险。相对于同等阈值的Centor评分，McIsaac评分具有更高的估计灵敏度和更低的特异性。但是具有广泛和重叠的信任区域。相对于每个人的RADT测试，使用任一评分作为RADT的分类来决定抗生素治疗将减少非GAS咽炎患者的抗生素处方，而且还减少了对GAS患者的抗生素处方。
结论：Centor和McIsaac评分对于在医院出现咽炎需要抗生素的患者分类同样无效。在高门槛下，错过了太多真正的阳性病例，在低门槛时，太多的假阳性被治疗，导致抗生素的过度处方。前者可以通过临床医生提供足够的安全网来补偿，确保患者在症状恶化时可以寻求帮助。
