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    FeverPAIN Score for Strep Pharyngitis

    Predicts likelihood of strep throat.
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    Patients with pharyngitis in primary care settings.

    • The FeverPAIN Score for Strep Pharyngitis was developed to try and help assess which patients with pharyngitis have streptococcal infections.

    • Developed in the setting of rapid antigen detection tests for multiple streptococcal strains (Group A, C, G).

    • While it should be further validated, it appeared to have better utility than the Centor Criteria at lower levels to detect patients who could forgo antibiotic treatment (Little 2014).

    • Caution should be advised in using the FeverPAIN Score to determine need for treatment in patients that have worsening symptoms beyond 3 days. Beyond this point, the clinician must consider the possibility of a more serious or invasive infection.

    • Should not be used in children <3 years old, as they are more likely to have viral infections and/or atypical presentations of streptococcal infection.

    Identifying the minority of pharyngitis patients with streptococcal infection can help providers reduce inappropriate antibiotic use in pharyngitis. The authors that derived the FeverPAIN Score performed an implementation study suggesting it can safely reduce antibiotic use by 30% (Little 2014).

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    Next Steps
    Evidence
    Creator Insights

    Advice

    A low FeverPAIN Score suggests streptococcal infection is unlikely.

    Critical Actions

    The FeverPAIN Score requires close examination of the pharynx and precise history taking.

    Content Contributors
    • Christian Hietanen, DO
    About the Creator
    Dr. Paul Little
    Are you Dr. Paul Little?
    Content Contributors
    • Christian Hietanen, DO