Abstract：
OBJECTIVE: To assess and compare the diagnostic performance of Clinical Prediction Rules (CPRs) developed to detect group A Beta-haemolytic streptococci in people with acute pharyngitis (or sore throat).
METHODS: A systematic review.
METHODS: We searched PubMed, Embase and Web of Science (inception-September 2022) for studies deriving and/or validating CPRs comprised of ≥2 predictors from an individual\'s history or physical examination. Two authors independently screened articles, extracted data and assessed risk of bias in included studies. A meta-analysis was not possible due to heterogeneity. Instead we compared the performance of CPRs when they were validated in the same study population (head-to-head comparisons). We used a modified grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess certainty of the evidence.
RESULTS: We included 63 studies, all judged at high risk of bias. Of 24 derived CPRs, 7 were externally validated (in 46 external validations). Five validation studies provided data for head-to-head comparison of four pairs of CPRs. Very low certainty evidence favoured the Centor CPR over the McIsaac (2 studies) and FeverPain CPRs (1 study) and found the Centor CPR was equivalent to the Walsh CPR (1 study). The AbuReesh and Steinhoff 2005 CPRs had a similar poor discriminative ability (1 study). Within and between study comparisons suggested the performance of the Centor CPR may be better in adults (>18 years).
CONCLUSIONS: Very low certainty evidence suggests a better performance of the Centor CPR. When deciding about antibiotic prescribing for pharyngitis patients, involving patients in a shared decision making discussion about the likely benefits and harms, including antibiotic resistance, is recommended. Further research of higher rigour, which compares CPRs across multiple settings, is needed.
METHODS: A systematic review.
METHODS: We searched PubMed, Embase and Web of Science (inception-September 2022) for studies deriving and/or validating CPRs comprised of ≥2 predictors from an individual\'s history or physical examination. Two authors independently screened articles, extracted data and assessed risk of bias in included studies. A meta-analysis was not possible due to heterogeneity. Instead we compared the performance of CPRs when they were validated in the same study population (head-to-head comparisons). We used a modified grading of recommendations, assessment, development, and evaluations (GRADE) approach to assess certainty of the evidence.
RESULTS: We included 63 studies, all judged at high risk of bias. Of 24 derived CPRs, 7 were externally validated (in 46 external validations). Five validation studies provided data for head-to-head comparison of four pairs of CPRs. Very low certainty evidence favoured the Centor CPR over the McIsaac (2 studies) and FeverPain CPRs (1 study) and found the Centor CPR was equivalent to the Walsh CPR (1 study). The AbuReesh and Steinhoff 2005 CPRs had a similar poor discriminative ability (1 study). Within and between study comparisons suggested the performance of the Centor CPR may be better in adults (>18 years).
CONCLUSIONS: Very low certainty evidence suggests a better performance of the Centor CPR. When deciding about antibiotic prescribing for pharyngitis patients, involving patients in a shared decision making discussion about the likely benefits and harms, including antibiotic resistance, is recommended. Further research of higher rigour, which compares CPRs across multiple settings, is needed.
摘要：
目的：评估和比较临床预测规则（CPRs）在急性咽炎（或咽喉痛）患者中用于检测A组β溶血性链球菌的诊断性能。
方法：系统评价。
方法：我们搜索了PubMed，Embase和WebofScience（2022年9月开始），用于从个人病史或体格检查中得出和/或验证由≥2个预测因子组成的CPRs的研究。两位作者独立筛选了文章，提取数据并评估纳入研究的偏倚风险。由于异质性，无法进行荟萃分析。相反，我们比较了在同一研究人群中验证的CPRs的性能（头对头比较）。我们使用了修改后的推荐等级，评估，发展,和评估(等级)方法来评估证据的确定性。
结果：我们纳入了63项研究，所有的人都被认为有很高的偏见风险。在24个衍生的CPR中，7个进行了外部验证(在46个外部验证中)。五项验证研究为四对CPR的头对头比较提供了数据。非常低的确定性证据使CentorCPR优于McIsaac（2项研究）和FeverPainCPRs（1项研究），并发现CentorCPR等同于WalshCPR（1项研究）。AbuReesh和Steinhoff2005年的CPR具有相似的差别性（1项研究）。在研究范围内和研究之间的比较表明，CentorCPR在成年人（>18岁）中的表现可能更好。
结论：非常低的确定性证据表明CentorCPR的表现更好。在决定咽炎患者的抗生素处方时，让患者参与关于可能的益处和危害的共同决策讨论，包括抗生素耐药性,是推荐的。更严格的进一步研究，它比较了多个设置中的CPR，是需要的。
方法：系统评价。
方法：我们搜索了PubMed，Embase和WebofScience（2022年9月开始），用于从个人病史或体格检查中得出和/或验证由≥2个预测因子组成的CPRs的研究。两位作者独立筛选了文章，提取数据并评估纳入研究的偏倚风险。由于异质性，无法进行荟萃分析。相反，我们比较了在同一研究人群中验证的CPRs的性能（头对头比较）。我们使用了修改后的推荐等级，评估，发展,和评估(等级)方法来评估证据的确定性。
结果：我们纳入了63项研究，所有的人都被认为有很高的偏见风险。在24个衍生的CPR中，7个进行了外部验证(在46个外部验证中)。五项验证研究为四对CPR的头对头比较提供了数据。非常低的确定性证据使CentorCPR优于McIsaac（2项研究）和FeverPainCPRs（1项研究），并发现CentorCPR等同于WalshCPR（1项研究）。AbuReesh和Steinhoff2005年的CPR具有相似的差别性（1项研究）。在研究范围内和研究之间的比较表明，CentorCPR在成年人（>18岁）中的表现可能更好。
结论：非常低的确定性证据表明CentorCPR的表现更好。在决定咽炎患者的抗生素处方时，让患者参与关于可能的益处和危害的共同决策讨论，包括抗生素耐药性,是推荐的。更严格的进一步研究，它比较了多个设置中的CPR，是需要的。
