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Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds
BACKGROUND: Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis. AIM: To compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with ph...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Royal College of General Practitioners
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065683/ https://www.ncbi.nlm.nih.gov/pubmed/32152041 http://dx.doi.org/10.3399/bjgp20X708833 |
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author | Willis, Brian H Coomar, Dyuti Baragilly, Mohammed |
author_facet | Willis, Brian H Coomar, Dyuti Baragilly, Mohammed |
author_sort | Willis, Brian H |
collection | PubMed |
description | BACKGROUND: Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis. AIM: To compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with pharyngitis. DESIGN AND SETTING: A meta-analysis of diagnostic test accuracy studies conducted in primary care was performed using a novel model that incorporates data at multiple thresholds. METHOD: MEDLINE, EMBASE, and PsycINFO were searched for studies published between January 1980 and February 2019. Included studies were: cross-sectional; recruited patients with sore throats from primary care; used the Centor or McIsaac score; had GABHS infection as the target diagnosis; used throat swab culture as the reference standard; and reported 2 × 2 tables across multiple thresholds. Selection and data extraction were conducted by two independent reviewers. QUADAS-2 was used to assess study quality. Summary receiver operating characteristic (SROC) curves were synthesised. Calibration curves were used to assess the transferability of results into practice. RESULTS: Ten studies using the Centor score and eight using the McIsaac score were included. The prevalence of GABHS ranged between 4% and 44%. The areas under the SROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The P-value for the difference (0.0164) was 0.419, suggesting the SROC curves for the tests are equivalent. Both scores demonstrated poor calibration. CONCLUSION: Both Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection. |
format | Online Article Text |
id | pubmed-7065683 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Royal College of General Practitioners |
record_format | MEDLINE/PubMed |
spelling | pubmed-70656832020-03-18 Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds Willis, Brian H Coomar, Dyuti Baragilly, Mohammed Br J Gen Pract Research BACKGROUND: Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis. AIM: To compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with pharyngitis. DESIGN AND SETTING: A meta-analysis of diagnostic test accuracy studies conducted in primary care was performed using a novel model that incorporates data at multiple thresholds. METHOD: MEDLINE, EMBASE, and PsycINFO were searched for studies published between January 1980 and February 2019. Included studies were: cross-sectional; recruited patients with sore throats from primary care; used the Centor or McIsaac score; had GABHS infection as the target diagnosis; used throat swab culture as the reference standard; and reported 2 × 2 tables across multiple thresholds. Selection and data extraction were conducted by two independent reviewers. QUADAS-2 was used to assess study quality. Summary receiver operating characteristic (SROC) curves were synthesised. Calibration curves were used to assess the transferability of results into practice. RESULTS: Ten studies using the Centor score and eight using the McIsaac score were included. The prevalence of GABHS ranged between 4% and 44%. The areas under the SROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The P-value for the difference (0.0164) was 0.419, suggesting the SROC curves for the tests are equivalent. Both scores demonstrated poor calibration. CONCLUSION: Both Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection. Royal College of General Practitioners 2020-03-10 /pmc/articles/PMC7065683/ /pubmed/32152041 http://dx.doi.org/10.3399/bjgp20X708833 Text en ©The Authors http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/). |
spellingShingle | Research Willis, Brian H Coomar, Dyuti Baragilly, Mohammed Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds |
title | Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds |
title_full | Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds |
title_fullStr | Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds |
title_full_unstemmed | Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds |
title_short | Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds |
title_sort | comparison of centor and mcisaac scores in primary care: a meta-analysis over multiple thresholds |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065683/ https://www.ncbi.nlm.nih.gov/pubmed/32152041 http://dx.doi.org/10.3399/bjgp20X708833 |
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