The Centor criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in adult patients complaining of a sore throat. They were developed as a method to quickly diagnose the presence of
Group A streptococcal infection
Group A streptococcal infections are a number of infections with ''Streptococcus pyogenes'' a group A streptococcus (GAS). ''S. pyogenes'' is a species of beta-hemolytic gram-positive bacteria that is responsible for a wide range of infections t ...
or diagnosis of
streptococcal pharyngitis
Streptococcal pharyngitis, also known as streptococcal sore throat (strep throat), is pharyngitis (an infection of the pharynx, the back of the throat) caused by ''Streptococcus pyogenes'' a gram-positive, group A streptococcus. Common symptom ...
in "adult patients who presented to an urban emergency room complaining of a sore throat."
The Centor criteria are named after Robert M. Centor, an
internist at the
University of Alabama at Birmingham School of Medicine
The University of Alabama at Birmingham Marnix E. Heersink School of Medicine is a public medical school located in Birmingham, Alabama, United States with branch campuses in Huntsville, Montgomery, and at the University of Alabama College o ...
.
Criteria
The patients are judged on four criteria, with one point added for each positive criterion:
* Absence of
cough
A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three pha ...
* Tonsillar
exudates
An exudate is a fluid emitted by an organism through pores or a wound, a process known as exuding or exudation.
''Exudate'' is derived from ''exude'' 'to ooze' from Latin ''exsūdāre'' 'to (ooze out) sweat' (''ex-'' 'out' and ''sūdāre'' 'to ...
(ooze)
* History of
fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
* Tender anterior cervical
adenopathy
Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammation, inflammatory type (the most common type) is lymphadenitis, producing swelling (medical), swolle ...
The modified Centor criteria also incorporate the patient's age:
* Age under 15 add 1 point
* Age over 44 subtract 1 point
Mnemonic using criteria name
A mnemonic to remember Centor is:
* C – Cough absent, or the incorrect but memorable "Can't Cough"
* E – Exudate
* N – Nodes
* T – temperature (fever)
* OR – young OR old modifier
Scoring
The point system is important in that it dictates management.
Scores may range from −1 to 5.
Guidelines for management state:
* -1, 0 or 1 point(s) – No antibiotic or throat culture necessary (risk of strep. infection <10%)
* 2 or 3 points – Should receive a throat culture and treat with an antibiotic if culture is positive (risk of strep. infection 32% if 3 criteria, 15% if 2)
* 4 or 5 points – Consider rapid strep testing and or culture. (Risk of strep. infection 56%) –
Infectious Diseases Society of America
The Infectious Diseases Society of America (IDSA) is a medical association representing physicians, scientists and other health care professionals who specialize in infectious diseases. It was founded in 1963 and is based in Arlington, Virginia. ...
and
American College of Physicians
The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults.Sokanu "What is an Internist?" Retrieved October 20, 2014 With 161,000 members, ACP is the largest ...
no longer recommend empiric treatment for strep based on symptomatology alone.
In the UK there is not a differentiator for age, and score ranges from 0 to 4, with 3–4 being offered treatment and no indication for swabs.
The presence of all four variables indicates a 40–60%
positive predictive value for a culture of the throat to test positive for Group A streptococcus bacteria. The absence of all four variables indicates a
negative predictive value of greater than 80%. The high negative predictive value suggests that the Centor criteria can be more effectively used for ruling out strep throat than for diagnosing strep throat.
The Centor criteria were originally developed for adults. A study published in the ''British Medical Journal'' in 2013 looked at whether it could be applied to children aged 2–16. It was a retrospective study (2008–2010) and looked at 441 children who attended a Belgian hospital emergency department and had a throat swab taken. It concluded that the Centor criteria are ineffective in predicting the presence of Group A beta-haemolytic streptococcus (i.e. antibiotic treatment-worthy) on throat swab cultures in children. A better score is the FeverPAIN score which is more evidence based
References
*
{{Common Cold
Streptococcal infections
Human throat
Medical scoring system
Medical mnemonics