The diagnosis of strep throat in adults in the emergency room

Med Decis Making. 1981;1(3):239-46. doi: 10.1177/0272989X8100100304.


Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.

MeSH terms

  • Adolescent
  • Adult
  • Decision Making*
  • Diagnosis, Differential
  • Humans
  • Pharyngeal Diseases / diagnosis*
  • Streptococcal Infections / diagnosis*
  • Streptococcus pyogenes