Clinical Decision Rules and Strategies for the Diagnosis of Group A Streptococcal Infection: A Review of Clinical Utility and Guidelines


Project Status:
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:


  1. What is the clinical utility of clinical decision rules for the initial screening of patients with suspected group A strep infection?

  2. What are the evidence-based guidelines regarding the diagnosis of suspected group A strep infection?

Key Message

Limited evidence of variable quality, suggests that the use of a clinical decision rule tool, for initial identification of patients with GA strep infection, may reduce unnecessary testing and inappropriate antibiotic use; however the findings were not always statistically significant.Three guidelines, which did not mention any specific clinical decision rule tool, recommend that if signs and symptoms are suggestive of bacterial infection then further testing should be undertaken. One guideline recommends the use of McIsaac tool to identify patients who warrant further testing. One guideline recommends the use FeverPAIN or Centor to identify patients who are likely to benefit from antibiotic treatment. Findings need to be interpreted in the light of limitations.