Streptococcal score for sore throat

What it is

The streptococcal score, also written as the modified Centor score or the McIsaac criteria, gives one point for each of: 1) absence of cough; 2) swollen, tender anterior cervical nodes; 3) a temperature above 38 C (100.4 F); 4) tonsillar exudate or swelling.

Age also carries points: 1) one point at 3 to 14 years; 2) none at 15 to 44 years; 3) minus one at 45 years or older. The points are added into a cumulative score, and that number carries both the chance the patient has strep and the action that follows.

Causes and risk

Most sore throats are not streptococcal at all. Viral infections account for around 90% of all sore throats, the common cold and the flu among them, and acute pharyngitis is commonly viral: Rhinoviruses, influenza and Adenovirus. The organisms that matter on the other side are GAS and Diphtheria. That is why the points are counted before a swab is sent.

How it presents

Acute pharyngitis runs from mild to very severe. Mild illness gives throat discomfort, malaise and low-grade fever with a congested pharynx. Moderate to severe illness adds dysphagia, headache and high fever, with erythema, exudate and enlarged tonsils and lymphoid follicles. Very severe illness brings edema of the soft palate and uvula with enlargement of the cervical nodes. Acute tonsillitis from GAS has its peak incidence between 5 and 12 years of age and has a rapid onset with fever, sore throat, headache, nausea, vomiting, dysphagia and abdominal pain.