|Symptoms||Increased Disease Probability (Positive Likelihood Ratio)|
|Strep exposure in the past 2 weeks||1.9× (1.3-2.8)|
|History of sore throat||1.0-1.1|
|Signs on Physical Exam||Increased Disease Probability (Positive Likelihood Ratio)|
|Tonsillar exudates||3.4× (1.8-6.0)|
|Pharyngeal exudates||2.1× (1.4-3.1)|
|Tonsillar or pharyngeal exudates||1.8× (1.5-2.3)|
|Palatine petechiae||1.4× (0.48-3.1)|
|Ant. Cervical lymph node tenderness||1.2-1.9|
|Measured temp >37.8 C||1.1-3.0|
|Male sex||0.87× (0.72-1.05)|
|Measured temp >=38.3 °C||0.68-3.9|
|Ant. Cervical lymph node swollen/enlarged||0.47-2.9|
|Centor Criteria Points (Ignoring Age Modification)||Increased Disease Probability (Positive Likelihood Ratio)|
|Symptoms||Decreased Disease Probability (Negative Likelihood Ratio)|
|History of sore throat||0.55-1.2|
|Strep exposure previous 2 wk||0.92× (0.86-0.99)|
|Signs on Physical Exam||Decreased Disease Probability (Negative Likelihood Ratio)|
|Measured temp >37.8 C||0.27-0.94|
|Measured temp >=38.3 C||0.54-1.3|
|Ant. Cervical lymph node swollen/enlarged||0.58-0.92|
|Ant. Cervical lymph node tenderness||0.60× (0.49-0.71)|
|Tonsillar swelling/enlargement||0.63× (0.56-0.72)|
|Tonsillar exudates||0.72× (0.60-0.88)|
|Tonsillar or pharyngeal exudates||0.74× (0.66-0.82)|
|Pharyngeal exudates||0.90× (0.75-1.1)|
|Palatine petechiae||0.98× (0.92-1.1)|
|Male sex||1.1× (0.93-1.2)|
Source: Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical
examination. Does this patient have strep throat? JAMA. 2000 Dec
13;284(22):2912-8. PubMed PMID: 11147989.
Narrative: The Bottom Line: Clinician judgment performs better when looking at the constellation of findings to determine diagnosis.
Author: Khaled Hassan, MD and Shahriar Zehtabchi, MD
Published/Updated: February 25, 2013
LR, pretest probability and posttest (or posterior) probability are daunting terms that describe simple concepts that we all intuitively understand.
Let's start with pretest probability: that's just a fancy term for my initial impression, before we perform whatever test it is that we're going to use.
For example, a patient with prior stents comes in sweating and clutching his chest in agony, I have a pretty high suspicion that he's having an MI – let's say, 60%. That is my pretest probability.
He immediately gets an ECG (known here as the "test") showing an obvious STEMI.
Now, I know there are some STEMI mimics, so I'm not quite 100%, but based on my experience I'm 99.5% sure that he's having an MI right now. This is my posttest probability - the new impression I have that the patient has the disease after we did our test.
And likelihood ration? That's just the name for the statistical tool that converted the pretest probability to the posttest probability - it's just a mathematical description of the strength of that test.
Using an online calculator, that means the LR+ that got me from 60% to 99.5% is 145, which is about as high an LR you can get (and the actual LR for an emergency physician who thinks an ECG shows an obvious STEMI).
(Thank you to Seth Trueger, MD for this explanation!)
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