Patient-clinician agreement on signs and symptoms of 'strep throat': a MetroNet study

Fam Pract. 2004 Dec;21(6):599-604. doi: 10.1093/fampra/cmh604. Epub 2004 Nov 4.


Background: Despite substantial use of the telephone in health care, only a few studies have formally evaluated the appropriateness of telephone-based management for acute medical problems. The accuracy of patients' report of signs and symptoms remains unknown.

Objective: We compared the agreement between patient self-assessment and clinician assessment on the typical signs and symptoms of group A beta-haemolytic Streptococcus (GABHS) to investigate the potential difficulties of using patient self-report to triage sore throat patients.

Methods: In this cross-sectional study, each of 200 adult pharyngitis patients was instructed to examine him/herself and to record the symptoms and physical findings. Two clinicians independently interviewed and examined each patient and recorded their findings. Each patient then had a rapid GABHS antigen test, the results of which were blinded to both clinicians and patients. Each patient self-assessment was compared with the findings of each clinician, and the agreement and disagreement between them computed.

Results: We found varying levels of agreement (kappa=-0.05 to 0.71) between patients and clinicians on sore throat history and physical assessments. Importantly, there was fair to substantial agreement (kappa=0.20-0.71) on the key signs and symptoms used in GABHS clinical prediction rules. As expected, history items had the highest agreement (kappa=0.52-0.71). Patients were more likely than clinicians to report rather than deny a specific physical sign.

Conclusion: Adult sore throat patients may reliably report their symptoms, but may not be able to assess and report accurately on relevant physical signs of pharyngitis. Patients have a tendency to over-report physical signs. This study indicates the potential difficulties associated with telephone triage of sore throat patients, or other illnesses that require assessment of physical signs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diagnosis, Differential
  • Family Practice / methods
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Medical History Taking
  • Michigan
  • Middle Aged
  • Observer Variation
  • Pharyngitis / diagnosis*
  • Physician-Patient Relations*
  • Streptococcal Infections / diagnosis*
  • Streptococcus pyogenes / isolation & purification
  • Telephone / statistics & numerical data*
  • Triage / methods*