Hümeyra ASLANER, Selçuk MISTIK, Gözde Ertürk ZARARSIZ, Hüseyin KILIÇ, Neriman ÇETİN BENLİ

Boğaz Ağrısında Mıstık Skoru ve Modifiye Centor Skoru’nun Kullanımının Değerlendirilmesi

Amaç: Akut tonsillofarenjitte, kullanılan çeşitli klinik skorlamalar mevcuttur. Streptokoksik farenjitini öngörmek için Modifiye Centor Skoru ve viral ajanlara tanı koymak için Mıstık Skoru geliştirilmiştir. Bu çalışma da birinci basamakta boğaz ağrısı şikayeti ile gelen hastaların hızlı antijen testi (HAT) sonuçlarına göre Modifiye Centor Skoru ve Mıstık Skoru’nun cutoff noktalarının belirlenmesi ve aile hekimleri tarafından kullanımının değerlendirilmesi amaçlandı. Gereç ve Yöntem: Aile sağlığı merkezlerine boğaz ağrısı şikayeti ile başvuran 3-80 yaş arasındaki 125 hasta dahil edildi. Hastaların fizik muayeneleri yapılıp Mıstık Skoru ve Modifiye Centor Skor’ları tespit edildi. Hastalara HAT uygulandı, verilen tedavi kaydedildi. Çalışmanın 2. aşamasında hastalara klinik skorlama uygulanıp Mıstık Skoru, Modifiye Centor Skoru ve HAT kullanımının değerlendirilmesi için doktorlara anket uygulandı. Bulgular: Modifiye Centor Skoru için en uygun kesim noktası 3 olup duyarlılığı %87.5 ve seçiciliği %86.2, pozitif kestirim değeri %48.3, negatif kestirim değeri %97.9 bulunmuştur. Mıstık Skoru için en uygun cutoff değeri 3 olup duyarlılığı %61 ve seçiciliği %87.5, pozitif kestirim değeri %97, negatif kestirim değeri %25 bulunmuştur. Aile hekimlerinin %75’i klinik skorlamayı rutin muayenede kullanıyordu ve en çok kullanılan skorlama yöntemi de ModifiyeCentor Skoru idi (%88.9). Aile hekimlerinin %75’i HAT’ a karar vermeden önce klinik skorlama kullanmaktadır. Sonuç: Günlük aile hekimliği pratiğinde çok sık görülen boğaz ağrısında Mıstık Skoru, Modifiye Centor Skoru gibi klinik skor kullanımı öncelikle HAT testinin uygun hastada yapılmasını sağlayacaktır. İlaveten aile hekimlerinin tonsillofarenjit konusunda daha uygun tedavi kararları vermesini sağlayacaktır. Bu yüzden klinik skorlamaların kullanımını ve özellikle viral bir skorlama olan Mıstık Skoru’nun kullanımını önermekteyiz.

Anahtar Kelimeler:

Boğaz ağrısı, Mıstık Skoru, Modifiye Centor Skoru, Hızlı Antijen Testi

Evaluation of the Use of the Mistik Score and Modified Centor Score in Sore Throat

Objective: There are various clinical scoring systems in acute tonsillopharyngitis. The Modified Centor Score was developed to predict streptococcal pharyngitis and the Mistik score was developed to diagnose viral agents. This study aimed to determine cut-off values of the Modified Centor Score and Mistik score according to rapid antigen detection test (RADT) results of patients admitted with sore throat in the primary care and evaluate the use of these scoring systems by family physicians. Methods: A total of 125 patients between the ages of 3 and 80 who were admitted with sore throat to the family health centers were included in the study. Physical examinations of the patients were performed and their Mistik and Modified Centor Scores were detected. Patients underwent RADT. Treatments of the patients were recorded. In the second stage of the study, patients underwent clinical scoring and the physicians completed a questionnaire to evaluate the use of the Mistik Score, Modified Centor Score and RADT. Results: The optimal cut-off value for the Modified Centor Score was 3, sensitivity was 87.5%, specificity was 86.2%, positive predictive value was 48.3% and negative predictive value was 97.9%. The optimal cut-off value for Mistik score was 3, sensitivity was 61%, specificity was 87.5%, positive predictive value was 97% and negative predictive value was 25%. Of the physicians, 75% used clinical scoring during routine examination and the most common scoring system used was the Modified Centor Score (88.9%). Of the physicians, 75% used clinical scoring before the decision of RADT. Conclusion: The use of clinical scoring systems such as the Mistik Score and Modified Centor Score will primarily allow RADT be used in the appropriate patient for sore throat that is very common in daily family practice. In addition, it will help family physicians decide on the best treatment options for tonsillopharyngitis. Therefore, we recommend the use of clinical scoring systems especially the Mistik Score, which is a viral scoring system.

Keywords:

Sore Throat, The Mistik Score, The Modified Centor Score, Rapid Antigen Detection Test,

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1. Smith JL. Pharyngitis. In: Paulman PM HJeTsMoFMP, 2007; pp. 274-276.
2. Bisno AL. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clinical infectious diseases. 2002;113-25.
3. Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics. 2009;123(2):437-44.
4. Hashigucci K, Matsunobu T. Etiology of acute pharyngitis in adults: the presence of viruses and bacteria. Nippon Jibiinkoka Gakkai Kaiho. 2003;106(5):532-9.
5. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Medical Decision Making. 1981;1(3):239-46.
6. Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, et al. Guideline for the management of acute sore throat: ESCMID Sore Throat Guideline Group. Clinical microbiology and infection. 2012;18:1-27.
7. Mistik S, Gokahmetoglu S, Balci E, Onuk FA. Sore throat in primary care project: a clinical score to diagnose viral sore throat. Family practice. 2015;32(3):263-8.
8. Bisno AL, Peter GS, Kaplan EL. Diagnosis of strep throat in adults: are clinical criteria really good enough? Clinical infectious diseases. 2002;35(2):126-9.
9. Gonzales R, Camargo Jr CA, MacKenzie T, Kersey AS, Maselli J, Levin SK, et al. Antibiotic treatment of acute respiratory infections in acute care settings. Academic emergency medicine. 2006;13(3):288-94.
10. Gerber MA. Comparison of throat cultures and rapid strep tests for diagnosis of streptococcal pharyngitis. The Pediatric infectious disease journal. 1989;8(11):820-4.
11. Carroll K, Reimer L. Microbiology and laboratory diagnosis of upper respiratory tract infections. Clinical infectious diseases. 1996;23(3):442-8.
12. Hoffmann S. Detection of group A streptococcal antigen from throat swabs with five diagnostic kits in general practice. Diagnostic microbiology and infectious disease. 1990;13(3):209-15.
13. Pontin IPO, Sanchez DCJ, Di Francesco R. Asymptomatic Group A Streptococcus carriage in children with recurrent tonsillitis and tonsillar hypertrophy. International journal of pediatric otorhinolaryngology. 2016;86:57-9.
14. Cabbarpur C, Büyüklü F, Çakmak Ö, Haşimoğlu R, Ergın F, Özhan Zr, et al. Akut tonsillofarenjitte rapid strep a testi kullanımı. KBB-Forum. 2004;3:10–2.
15. Little P, Hobbs FR, Moore M, Mant D, Williamson I, McNulty C, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). Bmj. 2013;347:f5806.
16. Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC pulmonary medicine. 2012;12(1):70.
17. Demoré B, Tebano G, Gravoulet J, Wilcke C, Ruspini E, Birgé J, et al. Rapid antigen test use for the management of group A streptococcal pharyngitis in community pharmacies. European Journal of Clinical Microbiology & Infectious Diseases. 2018:1-9.
18. Pulcini C, Rabaud C. Comment mieux prescrire les antibiotiques? La Revue du praticien. 2012;62(7).
19. Michel-Lepage A, Ventelou B, Verger P, Pulcini C. Factors associated with the use of rapid antigen diagnostic tests in children presenting with acute pharyngitis among French general practitioners. European journal of clinical microbiology & infectious diseases. 2014;33(5):723-8.

ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez