A Systematic Review of the Diagnostic Accuracy of McIsaac and Centor Scores in Secondary Care for Patients with Pharyngitis

Abstract

Background: The Centor and McIsaac scores are widely used clinical tools to predict group A streptococcus (GAS) infection in patients with pharyngitis. However, recommended thresholds for these scores vary across different clinical guidelines, leading to uncertainty in their application. Methods: Following PRISMA 2020 guidelines, this systematic review focused exclusively on full-text articles published in English between 2014 and 2024. Result: The study conducted a comprehensive review of over 100 publications sourced from reputable databases, including ScienceDirect, SagePub, and PubMed. Following an initial screening, five publications were identified as warranting more in-depth analysis. Consequently, a thorough review of these selected studies was performed to ensure a detailed and rigorous evaluation. Conclusion: Both the Centor and McIsaac scores show limited effectiveness in accurately triaging patients with pharyngitis for antibiotic treatment in secondary care settings. At higher score thresholds, a significant number of true GAS-positive cases are missed, while at lower thresholds, over-treatment occurs due to false positives. Clinicians can mitigate this risk by implementing robust safety netting practices, ensuring patients can seek further medical care if symptoms worsen or fail to improve. Overall, while these scores may reduce unnecessary antibiotic prescriptions, their use requires careful clinical judgment to avoid under-treatment of GAS infections.