Optimal management of adults with pharyngitis – a multi-criteria decision analysis
<p>Abstract</p> <p>Background</p> <p>Current practice guidelines offer different management recommendations for adults presenting with a sore throat. The key issue is the extent to which the clinical likelihood of a Group A streptococcal infection should affect patient...
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| Format: | Article |
| Language: | English |
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BMC
2006-03-01
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| Series: | BMC Medical Informatics and Decision Making |
| Online Access: | http://www.biomedcentral.com/1472-6947/6/14 |
| _version_ | 1818229204387364864 |
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| author | Dolan James G Singh Sonal Centor Robert M |
| author_facet | Dolan James G Singh Sonal Centor Robert M |
| author_sort | Dolan James G |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Current practice guidelines offer different management recommendations for adults presenting with a sore throat. The key issue is the extent to which the clinical likelihood of a Group A streptococcal infection should affect patient management decisions. To help resolve this issue, we conducted a multi-criteria decision analysis using the Analytic Hierarchy Process.</p> <p>Methods</p> <p>We defined optimal patient management using four criteria: 1) reduce symptom duration; 2) prevent infectious complications, local and systemic; 3) minimize antibiotic side effects, minor and anaphylaxis; and 4) achieve prudent use of antibiotics, avoiding both over-use and under-use. In our baseline analysis we assumed that all criteria and sub-criteria were equally important except minimizing anaphylactic side effects, which was judged very strongly more important than minimizing minor side effects. Management strategies included: a) No test, No treatment; b) Perform a rapid strep test and treat if positive; c) Perform a throat culture and treat if positive; d) Perform a rapid strep test and treat if positive; if negative obtain a throat culture and treat if positive; and e) treat without further tests. We defined four scenarios based on the likelihood of group A streptococcal infection using the Centor score, a well-validated clinical index. Published data were used to estimate the likelihoods of clinical outcomes and the test operating characteristics of the rapid strep test and throat culture for identifying group A streptococcal infections.</p> <p>Results</p> <p>Using the baseline assumptions, no testing and no treatment is preferred for patients with Centor scores of 1; two strategies – culture and treat if positive and rapid strep with culture of negative results – are equally preferable for patients with Centor scores of 2; and rapid strep with culture of negative results is the best management strategy for patients with Centor scores 3 or 4. These results are sensitive to the priorities assigned to the decision criteria, especially avoiding over-use versus under-use of antibiotics, and the population prevalence of Group A streptococcal pharyngitis.</p> <p>Conclusion</p> <p>The optimal clinical management of adults with sore throat depends on both the clinical probability of a group A streptococcal infection and clinical judgments that incorporate individual patient and practice circumstances.</p> |
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| format | Article |
| id | doaj.art-a683a6f3e51b435cbe5bfb56957c9b74 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-12T10:14:53Z |
| publishDate | 2006-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-a683a6f3e51b435cbe5bfb56957c9b742022-12-22T00:27:42ZengBMCBMC Medical Informatics and Decision Making1472-69472006-03-01611410.1186/1472-6947-6-14Optimal management of adults with pharyngitis – a multi-criteria decision analysisDolan James GSingh SonalCentor Robert M<p>Abstract</p> <p>Background</p> <p>Current practice guidelines offer different management recommendations for adults presenting with a sore throat. The key issue is the extent to which the clinical likelihood of a Group A streptococcal infection should affect patient management decisions. To help resolve this issue, we conducted a multi-criteria decision analysis using the Analytic Hierarchy Process.</p> <p>Methods</p> <p>We defined optimal patient management using four criteria: 1) reduce symptom duration; 2) prevent infectious complications, local and systemic; 3) minimize antibiotic side effects, minor and anaphylaxis; and 4) achieve prudent use of antibiotics, avoiding both over-use and under-use. In our baseline analysis we assumed that all criteria and sub-criteria were equally important except minimizing anaphylactic side effects, which was judged very strongly more important than minimizing minor side effects. Management strategies included: a) No test, No treatment; b) Perform a rapid strep test and treat if positive; c) Perform a throat culture and treat if positive; d) Perform a rapid strep test and treat if positive; if negative obtain a throat culture and treat if positive; and e) treat without further tests. We defined four scenarios based on the likelihood of group A streptococcal infection using the Centor score, a well-validated clinical index. Published data were used to estimate the likelihoods of clinical outcomes and the test operating characteristics of the rapid strep test and throat culture for identifying group A streptococcal infections.</p> <p>Results</p> <p>Using the baseline assumptions, no testing and no treatment is preferred for patients with Centor scores of 1; two strategies – culture and treat if positive and rapid strep with culture of negative results – are equally preferable for patients with Centor scores of 2; and rapid strep with culture of negative results is the best management strategy for patients with Centor scores 3 or 4. These results are sensitive to the priorities assigned to the decision criteria, especially avoiding over-use versus under-use of antibiotics, and the population prevalence of Group A streptococcal pharyngitis.</p> <p>Conclusion</p> <p>The optimal clinical management of adults with sore throat depends on both the clinical probability of a group A streptococcal infection and clinical judgments that incorporate individual patient and practice circumstances.</p>http://www.biomedcentral.com/1472-6947/6/14 |
| spellingShingle | Dolan James G Singh Sonal Centor Robert M Optimal management of adults with pharyngitis – a multi-criteria decision analysis BMC Medical Informatics and Decision Making |
| title | Optimal management of adults with pharyngitis – a multi-criteria decision analysis |
| title_full | Optimal management of adults with pharyngitis – a multi-criteria decision analysis |
| title_fullStr | Optimal management of adults with pharyngitis – a multi-criteria decision analysis |
| title_full_unstemmed | Optimal management of adults with pharyngitis – a multi-criteria decision analysis |
| title_short | Optimal management of adults with pharyngitis – a multi-criteria decision analysis |
| title_sort | optimal management of adults with pharyngitis a multi criteria decision analysis |
| url | http://www.biomedcentral.com/1472-6947/6/14 |
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