¿Es posible el diagnóstico clínico de la faringoamigdalitis estreptocócica?

ObjetivoDeterminar la validez de la puntuación de Centor (adenopatías cervicales, exudado amigdalar, fiebre y ausencia de síntomas catarrales) para filiar la faringoamigdalitis de origen estreptocócico.DiseñoEstudio descriptivo.EmplazamientoCentro de Salud San Fernando 2 (zona periurbana de Madrid).ParticipantesSe incluyó a 140 pacientes mayores de 14 años que acudieron a la consulta entre el 14 de febrero y el 12 de mayo de 2005 con «dolor de garganta» como principal síntoma.Mediciones principalesSe determinaron la sensibilidad (S), la especificidad (E), los valores predictivos postivo y negativo (VPP y VPN) y los cocientes de probabilidad de la puntuación de Centor; se utilizó el frotis faríngeo como método de referencia.ResultadosEn total, 34 pacientes presentaron frotis positivo (24,3%; intervalo de confianza [IC] del 95%, 17,6-32,4%). El hallazgo de los 4 criterios de Centor presentaba un VPP del 48,1% (IC del 95%, 30,7-66,0%) y un VPN del 81,4% (IC del 95%, 73,3-87,5%), aunque sólo la fiebre (odds ratio [OR]=3,64; IC del 95%, 1,40- 9,49) y el exudado amigdalar (OR=6,18; IC del 95%, 2,08-18,35) muestran asociación con la etiología estreptocócica.ConclusionesEl sistema de puntuación clínica alcanza un alto VPN y una especificidad que permiten diagnosticar con bastante certeza las faringoamigdalitis no estreptocócicas. Sin embargo, su VPP es bajo: una puntuación alta (3 o 4 criterios) no asegura que sea una faringoamigdalitis estreptocócica. Queda por resolver qué actitud se debe adoptar ante estos pacientes con sospecha de faringitis estreptocócica: test microbiológico, antibioterapia inmediata o antibioterapia diferida.ObjectiveTo determine the validity of the Centor score (cervical adenopathy, tonsillar exudate, fever, and absence of catarrh symptoms) in diagnosing streptococcal pharyngitis (gold standard: throat swab).DesignDescriptive study.SettingSan Fernando 2 Health Centre, Madrid (outer urban area), Spain.ParticipantsOn hundred forty patients over 14 years old who had a “sore throat” as main symptom and attended clinic between 14 February and 12 May, 2005.Main measurementsSensitivity, specificity, positive and negative predictive values, and the probability quotients of the Centor score were determined. Pharyngeal throat culture was used as the reference method.ResultsThirty four patients had positive throat culture (24.3%; 95% CI, 17.6%-32.4%). Finding the 4 criteria in the Centor score had a positive predictive value (PPV) of 48.1% (95% CI, 30.7%-66.0%) and a negative predictive value (NPV) of 81.4% (95% CI, 73.3%-87.5%); although only fever (OR, 3.64; 95% CI, 1.40-9.49) and tonsillar exudate (OR, 6.18; 95% CI, 2.08-18.35) were linked to streptococcal aetiology.ConclusionsThe high NPV and specificity of the clinical score makes the diagnosis of non-streptococcal pharyngitis very accurate. However, the PPV is low: a high Centor score (3 or 4 criteria) does not mean streptococcal pharyngitis with certainty.What approach to take with patients suspected of streptococcal pharyngitis is not yet resolved (microbiological test, early antibiotic, or postponed antibiotic)

A cluster-randomised clinical trial comparing two cardiovascular health education strategies in a child population: the Savinghearts project

<p>Abstract</p> <p>Background</p> <p>This paper describes a methodology for comparing the effects of an eduentertainment strategy involving a music concert, and a participatory class experience involving the description and making of a healthy breakfast, as educational vehicles for delivering obesity-preventing/cardiovascular health messages to children aged 7–8 years.</p> <p>Methods/design</p> <p>This study will involve a cluster-randomised trial with blinded assessment. The study subjects will be children aged 7–8 years of both sexes attending public primary schools in the Madrid Region. The participating schools (n=30) will be randomly assigned to one of two groups: 1) Group MC, in which the children will attend a music concert that delivers obesity-preventing/cardiovascular health messages, or 2) Group HB, in which the children will attend a participatory class providing the same information but involving the description and making of a healthy breakfast. The main outcome measured will be the increase in the number of correct answers scored on a knowledge questionnaire and in an attitudes test administered before and after the above interventions<it>.</it> The secondary outcome recorded will be the reduction in BMI percentile among children deemed overweight/obese prior to the interventions. The required sample size (number of children) was calculated for a comparison of proportions with an α of 0.05 and a β of 0.20, assuming that the Group MC subjects would show values for the measured variables at least 10% higher than those recorded for the subjects of Group HB. Corrections were made for the design effect and assuming a loss to follow-up of 10%. The maximum sample size required will be 2107 children. Data will be analysed using summary measurements for each cluster, both for making estimates and for hypothesis testing. All analyses will be made on an intention-to-treat basis.</p> <p>Discussion</p> <p>The intervention providing the best results could be recommended as part of health education for young schoolchildren.</p> <p>Trial registration</p> <p>Clinicaltrials.gov: NCT01418872</p