Strep scorecard may save time and money

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Strep throat, caused by the bacteria Group A streptococcus, accounts for about 10 percent of sore throat cases in adults and about 30 percent of sore throat cases in children. It is most common in children between the ages of five and 15. Yet, there more than 12 million doctors visits each year for sore throats, for most of which the only cure is rest and waiting. However, this may change soon. According to an article published in Annals of Internal Medicine, researchers are in the process of developing a new scorecard that may reduce unnecessary doctor visits.

Researchers from the Boston Children s Hospital led by Drs. Kenneth Mandl and Andrew Fine, looked at records of about 70,000 sore-throat patients who got strep tests at CVS Minute Clinics between 2006 and 2008. (CVS Minute Clinics are medical clinics located in CVS pharmacies that do not require appointments). They compared the scorecard approach with the actual diagnosis to determine its accuracy. The proposed scorecard looks at current symptoms, age and location of the patient, to assess whether there is group-A strep endemic in the region, in order to determine a person s risk of strep. Their estimations indicated that the scorecard approach could save about 230,000 doctors visits each year, but would miss about 8,500 cases of strep. However, according to researchers, most strep infections do clear up on their own.

This scorecard approach could also be important for another reason. Although doctors should only be prescribing antibiotics in strep throat cases, according to research published in JAMA Internal Medicine, about 60 percent of adults visiting their doctors for a sore throat were prescribed antibiotics, mostly unneeded.

In an editorial accompanying the article, Dr. Robert Centor of the University of Alabama, questions whether average patients would be receptive to this approach before ultimately deciding to see their doctor.

ACSH s Dr. Gilbert Ross adds, There are a lot of unnecessary strep tests being done, given that strep is very uncommon in persons over 15 years of age. This scorecard approach has the potential to raise people s awareness that their risk of strep is low, saving them a lot of time and money. However, when people are in pain, they are often quick to seek remedies, and doctors are often quick to provide them. We do need to add, however, that in youngsters, missing group A strep can be disastrous, since such infections can, infrequently, lead to acute rheumatic fever with kidney and heart complications. This is not a real concern in adults, which is where the scorecard s utility may be maximal.