Personal tools
You are here: Home / OSCAR Users / EMR and Case Management Resources / eForms / eForms for download / Calculators / Pharyngitis Risk Score - 2018
Navigation
 

Pharyngitis Risk Score - 2018

Updated from original work by Dr. David Page. Contributions from Drs. G Klein, H Chang, and J Yap. Only HTML - not a zip file. Not for import.

HTML icon Centor_Score_V3_Aug11_2018.html — HTML, 16 kB (16951 bytes)

File contents

<html>
<head>
<title>Pharyngitis Risk Score</title>

<!-- Based on original work by Dr David Page with the McIsaak Pharyngitis Risk Score E-form -->
<!-- updated by Gunther Klein and John Yap to the Modified Centor Score in current general clinical use Aug 2018. -->
<!-- This version is a collaborative effort between Drs. G Klein, H Chang, and J Yap. -->

<!-- Do not use apostrophes in text, only in html-required coding - they do not allow for proper eForm zip inside Oscar.  Instead, use: &#8217; -->

<!--
E-FORM DISCLAIMER: As is: E-Forms are shared as-is, free of charge on a share-alike basis with absolutely no guarantee or warranty. 
No Quality Control: The author does not vet any E-Forms and does not purport to apply any manner of quality control. 
Responsibility: The responsibility for the clinical and medical-legal consequences of any and all E-Forms, rest with the clinical OSCAR end-users themselves, not with the author of the eForm. This applies to both E-Forms shared by others, and those created by users themselves.
Attribution: E-Forms are shared freely among the user community, with attribution to the original author of the eForm. 
Free: E-Forms so shared may not be sold or purchased. 
Provincial validation:  E-Forms are optional and non-essential add-ons, separate from OSCAR, and with their own license terms.E-Forms  are not part of the OSCAR core program functionality and code base. 
For this reason E-Forms are not subject to provincial validation testing and conformance criteria. E-Forms are also not subject to the ISO production process for OSCAR.
-->

<style type="text/css">
p.title{
	text-transform: uppercase;
	font-size: 16;
	font-family: Arial;
	font-weight: bolder;
	text-align: left;
	color:  #505050;
}
p.heading{
	font-size: 12;
	font-family: Arial;
	font-weight: bolder;
	text-align: left;
	vertical-align: top;
	color:  #505050;
}
p.normaltext{
	font-size: 12;
	font-family: Arial;
	font-weight: normal;
	text-align: left;
	vertical-align: top;
	color:  #505050;
}
p.smalltext{
	font-size: 11;
	font-family: Arial;
	font-weight: normal;
	text-align: left;
	vertical-align: top;
	color:  #505050;
}
td.heading1{
	font-size: 12;
	font-family: Arial;
	font-weight: bold;
	text-align: left;
	vertical-align: top;
	color: white;
	background-color:#505050 ;
	border-width: 1;
}
td.QuestionHeading{
	font-size: 12;
	font-family: Arial;
	font-weight: bold;
	text-align: left;
	vertical-align: top;
	color: white;
	background-color: #505050;
	border-width: 1;
}
td.AnswerHeading{
	font-size: 12;
	font-family: Arial;
	font-weight: bold;
	text-align: center;
	vertical-align: top;
	color: white;
	background-color: #505050;
	border-width: 1;
}
td.question{
	font-size: 12;
	font-family: Arial;
	font-weight: normal;
	text-align: left;
	vertical-align: top;
	color: black;
	border-width: 1;
}
td.answer{
	font-size: 12;
	font-family: Arial;
	font-weight: bold;
	text-align: center;
	vertical-align: middle;
	color: black;
	border-width: 1;
}
td.normaltext{
	width: 100%;
	font-size: 12;
	font-family: Arial;
	font-weight: normal;
	text-align: left;
	vertical-align: top;
	color: black;
	background-color: white;
	border-width: 0;
}
input.formtext{
	width: 100%;
	height: 100%;
	font-size: 12;
	font-family: Arial;
	font-weight: normal;
	text-align: left;
	vertical-align: top;
	color: black;
	background-color: white;
	border-width: 1;
	border-style: solid; 
}
textarea.formtext{
	width: 100%;
	height: auto;
	font-size: 12;
	font-family: Arial;
	font-weight: normal;
	text-align: left;
	vertical-align: top;
	color: black;
	background-color: white;
	border-width: 1;
	border-style: solid;
}
</style>

<!-- style script for the cursor hover effect -->
<style>
#recommendations tr:nth-child(even){background-color: #f2f2f2;}
#recommendations tr:hover {background-color: #ffffcc;}
#questionnaire tr:nth-child(even){background-color: #f2f2f2;}
#questionnaire tr:hover {background-color: #ffffcc;}
</style>

<!-- Script to maximize window on loading -->
<script language="JavaScript1.2">
<!--
top.window.moveTo(0,0);
if (document.all) {
top.window.resizeTo(screen.availWidth,screen.availHeight);
}
else if (document.layers||document.getElementById) {
if (top.window.outerHeight<screen.availHeight||top.window.outerWidth<screen.availWidth){
top.window.outerHeight = screen.availHeight;
top.window.outerWidth = screen.availWidth;
}
}
//-->
</script>
<!-- End maximizing window script -->

<!-- CSS Script that removes textarea and textbox borders when printing - (put this in between <header></header>) -->
<style type="text/css" media="print">
.DoNotPrint {display: none;}

.noborder {
	scrollbar-3dlight-color: transparent;
	scrollbar-3dlight-color: transparent;
	scrollbar-arrow-color: transparent;
	scrollbar-base-color: transparent;
	scrollbar-darkshadow-color: transparent;
	scrollbar-face-color: transparent;
	scrollbar-highlight-color: transparent;
	scrollbar-shadow-color: transparent;
	scrollbar-track-color: transparent;
	background: transparent;
	overflow: hidden;
	border : 0px;
}
</style>

<script type="text/javascript" language="javascript">
	function passAge() {
		if (document.getElementById("Age").value >= 45) {
			document.getElementById("45").checked=true;
		}
		else if ((document.getElementById("Age").value <45) && (document.getElementById("Age").value >=15)) {
			document.getElementById("15").checked=true;
		}
		else if ((document.getElementById("Age").value <15) && (document.getElementById("Age").value >=3)) {
			document.getElementById("3").checked=true;
		}
		else if (document.getElementById("Age").value <3) {
			document.getElementById("warning").style.background='Tomato';
		}
	}

	function getCheckedValue(radioObj) {
		if(!radioObj)
		return parseInt(0);
	var radioLength = radioObj.length;
		if(radioLength == undefined)
		if(radioObj.checked)
		return parseInt(radioObj.value);
		else
			return parseInt(value);
	for(var i = 0; i < radioLength; i++) {
		if(radioObj[i].checked) {
		return parseInt(radioObj[i].value);
		}
	}
	
	return parseInt(0);
	}

	function totalScore() {
		var i = 0;
	
		i += getCheckedValue(document.FormName.Q1);
		i += getCheckedValue(document.FormName.Q2);
		i += getCheckedValue(document.FormName.Q3);
		i += getCheckedValue(document.FormName.Q4);
		i += getCheckedValue(document.FormName.Q5);

		document.FormName.Score.value = i;
		document.FormName.subject.value = 'Centor score = ' + i + '/5';
	
	if (i<=0){
		document.getElementById("lowest").style.background='lightgreen';
		document.getElementById("low").style.background='white';
		document.getElementById("mild").style.background='#f2f2f2';
		document.getElementById("moderate").style.background='white';
		document.getElementById("severe").style.background='#f2f2f2';
	}
	else if (i==1){
		document.getElementById("lowest").style.background='#f2f2f2';
		document.getElementById("low").style.background='lightgreen';
		document.getElementById("mild").style.background='#f2f2f2';
		document.getElementById("moderate").style.background='white';
		document.getElementById("severe").style.background='#f2f2f2';
	}
	else if (i==2){
		document.getElementById("lowest").style.background='#f2f2f2';
		document.getElementById("low").style.background='white';
		document.getElementById("mild").style.background='peachpuff';
		document.getElementById("moderate").style.background='white';
		document.getElementById("severe").style.background='#f2f2f2';
	}
	else if (i==3){
		document.getElementById("lowest").style.background='#f2f2f2';
		document.getElementById("low").style.background='white';
		document.getElementById("mild").style.background='#f2f2f2';
		document.getElementById("moderate").style.background='peachpuff';
		document.getElementById("severe").style.background='#f2f2f2';
	}
	else if (i==4) {
		document.getElementById("lowest").style.background='#f2f2f2';
		document.getElementById("low").style.background='white';
		document.getElementById("mild").style.background='#f2f2f2';
		document.getElementById("moderate").style.background='white';
		document.getElementById("severe").style.background='lightcoral';
	}
	else if (i==5) {
		document.getElementById("lowest").style.background='#f2f2f2';
		document.getElementById("low").style.background='white';
		document.getElementById("mild").style.background='#f2f2f2';
		document.getElementById("moderate").style.background='white';
		document.getElementById("severe").style.background='lightcoral';
	}
}
</script>
</head>

<body onload="passAge();">
<form method="post" action="" name="FormName">

<p class="title">
	Modified Centor Pharyngitis Risk Score
</p>

<div name="demographics">
<table width="50%">
	<tr><td class="heading1" width=25%>Patient name</td>
		<td class="formtext"><input class="formtext" name="PatientName" type="text" oscarDB=patient_name>
	</td></tr>
	<tr><td class="heading1">Date:</td>
		<td class="formtext"><input class="formtext" name="TodaysDate" type="text" oscarDB=today>
	</td></tr>
	<tr><td class="heading1">Patients age:</td>
		<td class="formtext"><input class="formtext" name="Age" id="Age" type="text" oscarDB=age>
	</td></tr>
</table>
</div>

<br>

<div name="warning">
<table width="50%">
	<tr><td width=100% class="normaltext" id="warning" style="text-align:center;">This score is not suitable for patients younger than 3 years of age, due to lower risk of Group A Streptococcus (GAS) in this age group. <br>Score intended for use <b>within first three days</b> of symptoms onset.
	</td></tr>
</table>
</div>

<br>

<div name="Questionnaire">
<table id="questionnaire" width="50%">
	<tr><td class="QuestionHeading" width=60%>Clinical Criteria</u>:</td>
		<td class="AnswerHeading" width=20%>Absent</td>
		<td class="AnswerHeading" width=20%>Present
	</td></tr>

	<tr id="question1">
		<td class="question"><p class="normal">Tonsillar swelling or exudate </p></td>
		<td class="answer"><input type="radio" name="Q1" value="0"></td>
		<td class="answer"><input type="radio" name="Q1" value="1"></td>
	</tr>

	<tr id="question2">
		<td class="question"><p class="normal">Tender anterior cervical adenopathy</p></td>
		<td class="answer"><input type="radio" name="Q2" value="0"></td>
		<td class="answer"><input type="radio" name="Q2" value="1"></td>
	</tr>

	<tr id="question3">
		<td class="question"><p class="normal">Fever over 38.0 C</p></td>
		<td class="answer"><input type="radio" name="Q3" value="0"></td>
		<td class="answer"><input type="radio" name="Q3" value="1"></td>
	</tr>

	<tr id="question4">
		<td class="question"><p class="normal">Cough</p></td>
		<td class="answer"><input type="radio" name="Q4" value="1"></td>
		<td class="answer"><input type="radio" name="Q4" value="0"></td>
	</tr>

	<tr id="question51">
		<td class="question"><p class="normal">Age 45+ yrs</p></td>
		<td class="answer"></td>
		<td class="answer"><input type="radio" name="Q5" id="45" value="-1"></td>
	</tr>
        
	<tr id="question52">
		<td class="question"><p class="normal">Age 15 - 44 yrs</p></td>
		<td class="answer"></td>
		<td class="answer"><input type="radio" name="Q5" id="15" value="0"></td>
	</tr>

	<tr id="question53">
		<td class="question"><p class="normal">Age 3 - 14 yrs</p></td>
		<td class="answer"></td>
		<td class="answer"><input type="radio" name="Q5" id="3" value="1"></td>
	</tr>
</table>

<br>

<table>
	<tr><td><input type="button" onclick="totalScore()" value="Calculate pharyngitis risk score"></td>
	<td><input type="text" style="font-weight:bolder" name="Score" size="3" value="">
	</td></tr>
</table>
</div>

<br>

<div name="Application" class="DoNotPrint">
<table id="recommendations" width=50%>
	<tr><td class="heading1" colspan="2">Recommendations</td></tr>

	<tr id="lowest">
		<td class="question">Centor Score 0 =</td>
		<td class="question">1-2.5% risk of GAS: No further testing or antibotics</td>
	</tr>

	<tr id="low">
		<td class="question">Centor Score 1 =</td>
		<td class="question">5-10% risk of GAS: No further testing or antibotics</td>
	</tr>

	<tr id="mild">
		<td class="question">Centor Score 2 =</td>
		<td class="question">11-17% risk of GAS: Optional rapid strep testing and/or culture</td>
	</tr>

	<tr id="moderate">
		<td class="question">Centor Score 3 =</td>
		<td class="question">28-35% risk of GAS: Consider rapid strep testing and/or culture</td>
	</tr>

	<tr id="severe">
		<td class="question">Centor Score 4-5 =</td>
		<td class="question">51-53% risk of GAS: Perform rapid strep testing and/or culture</td>
	</tr>
</table>

<br>

<div name="Application" class="DoNotPrint">
<table width=50%>
	<tr><td class="heading1" colspan="2">Notes:</td></tr>

	<tr><td>
<p class="smalltext">
Risk is dependent of the prevalence of Group A Streptococcus (GAS) which is seasonal. <b>IDSA and ASIM no longer recommend empiric treatment for Strep based on symptomatology alone.</b>
</p>

<p class="smalltext">
The original study by Centor et al was done in 1981 to develop criteria to diagnose GAS infection in adult patients presenting to the emergency department with sore throat (Centor 1981). The original model designated four criteria: tonsillar exudates, swollen tender anterior cervical nodes, absence of a cough, and history of fever. Patients exhibiting all four variables had a 56% probability of a Group A beta strep positive culture; three variables, 32%; two variables, 15%; one variable, 6.5%; and zero variables, 2.5%.
</P>

<p class="smalltext">
The Centor Score was later modified to include age (McIsaac 1998) and validated (McIsaac 2004) for use in both children and adults presenting with sore throat. McIsaac et al (1998) determined that using the Centor Score would reduce the number of unnecessary initial antibiotic prescriptions by 48%, without an increase in throat culture use.
</p>

<p class="smalltext">
The Centor Score and its modifications were derived in relatively small samples (n=286 and n=521, respectively). In order to more precisely classify the risk of GAS infection, Fine et al (2012) performed a national-scale validation of the score on a geographically diverse population of over 140,000 patients presenting in a clinical setting. The study was carried out over the course of more than a year, mitigating any impact of seasonality of GAS incidence on the results. This analysis provided more precise interpretations of risk for each category of the Centor Score; these still fell within the 95% confidence interval of Centor's original study with a much smaller sample size.
</p>

<p class="smalltext">
In their comparison of the Centor Score with other identification and treatment strategies, McIsaac et al (2004) found that use of the score resulted in fewer overall tests (cultures and rapid tests) per person but more throat cultures (96.1% of adults) than other strategies. As a result, the Centor Score represented a compromise, requiring the least diagnostic testing, providing 100% sensitivity and greater than 90% specificity in both children and adults, and producing significant reductions in unnecessary use of antibiotics, compared to other strategies.
</p>

<p class="smalltext">
Harris et al (2016) encourage the use of the Centor Score primarily to identify patients with a low probability of Group A streptococcal pharyngitis who do not warrant further testing, citing the criteria&#8217;s low positive predictive value.
</p>

<p class="smalltext">
<a href="https://www.mdcalc.com/centor-score-modified-mcisaac-strep-pharyngitis#evidence" target="_blank">Adapted from MDcalc.com</a>
</p>
	</td></tr>
</table>
</div>

<br>

<!-- The submit/print/reset buttons -->
<div name="FunctionButtons" class="DoNotPrint">
	<table><tr><td class="subjectline">
		Subject: <input name="subject" size="40" type="text">
		<input value="Submit" name="SubmitButton" type="submit">
		<input value="Reset" name="ResetButton" type="reset" onClick="history.go(0)">
		<input value="Print" name="PrintButton" onclick="javascript:window.print()" type="button">
	</td></tr></table>
</div>

</form>
<!-- End of submit/print/reset buttons -->

<br>

<div class="DoNotPrint" id="Licenseparagraph" style="position:relative; font-size:12px;">
	<a rel="license" href="http://creativecommons.org/licenses/by-sa/3.0/deed.en_US">
	<img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-sa/3.0/80x15.png" /></a> 

<br>
<br>

<span xmlns:dct="http://purl.org/dc/terms/" property="dct:title">This E-form</span>
<span xmlns:cc="http://creativecommons.org/ns#" property="cc:attributionName"></span> is licensed under a 
<a rel="license" href="http://creativecommons.org/licenses/by-sa/3.0/deed.en_US">Creative Commons Attribution-ShareAlike 3.0 Unported License</a>.

<br>

A collaborative effort shared by Drs. G. Klein, H. Chang, and J. Yap.
<br>

Permissions beyond the scope of this license may be available at <a xmlns:cc="http://creativecommons.org/ns#" href="http://www.oscarcanada.org/" rel="cc:morePermissions">http://www.oscarcanada.org/</a>.
</div>

</body>
</html>

Document Actions

 

Download button

DOWNLOAD OSCAR FOR TESTING

 

eForms button

DOWNLOAD SHARED E-FORMS


 Customize button

FIND PLUG-INS AND TWEAKS
FOR YOUR OSCAR EMR

 

Subscribe Button

SUBSCRIBE TO DISCUSSION LIST 
(SEE ALL LISTS)

  

Help button

ACCESS THE ONLINE MANUALS
(PAID SUPPORT)