The Centor criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in 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 infectio ...

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 sy ...

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 Internal medicine, also known as general medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of th ...

at the University of Alabama at Birmingham School of Medicine.

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 which can help clear them of fluids, irritants, foreign particles and Microorganism, microbes. As a protective reflex, coughing can be repetitive with the cough reflex fol ...

* Tonsillar

exudates An exudate is a fluid released by an organism through pores or a wound, a process known as exuding or exudation. ''Exudate'' is derived from ''exude'' 'to ooze' from Latin 'to (ooze out) sweat' (' 'out' and ' 'to sweat'). Medicine An exudate ...

(ooze) * History of

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

* 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 Philadelphia-based national organization of internal medicine physicians, who specialize in the diagnosis, treatment, and care of adults. With 161,000 members, ACP is the largest medical-specialty or ...

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 The positive and negative predictive values (PPV and NPV respectively) are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results, respectively. The PPV and NPV desc ...

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 The positive and negative predictive values (PPV and NPV respectively) are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results, respectively. The PPV and NPV desc ...

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.

References

* {{Common Cold Streptococcal infections Human throat Medical scoring system Medical mnemonics