Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old.
There are 2 schools of thought about whether to use the Modified Centor Scoring system at all. One school (ACP, CDC, AAFP) recommends using the scoring system to guide testing and treatment. For patients with 4 or 5 points, don’t even both testing. Just treat.
The other school of thought (AAP and IDSA) recommends testing everyone with ANY symptoms. They don’t recommend using the Centor scores for making any clinical judgment, because of the insensitivity of any single sign/symptom.
Which school of thought do you subscribe to?
Personally, I use the Modified Centor Score to determine testing and treatment. It is more cost-effective, time-efficient, and supported by the literature. It eliminates both the very low and very high pre-test probability patients from rapid antigen testing. You either withhold or prescribe antibiotics, respectively.
PV Card: Streptococcal Pharyngitis
Adapted from  Go to ALiEM (PV) Cards for more resources.
- Choby B. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009;79(5):383-390. [PubMed]