FeverPAIN Score

Predicts likelihood of streptococcus caused pharyngitis and whether the strep throat patient will require antibiotics.

Refer to the text below the calculator for more information about this screening method.


It is clinically important to discern whether the strep throat patient’s pharyngitis is caused by a viral (most cases) or bacterial agent (streptococcal infections with Group A, Group C or G).

The FeverPAIN predicts the likelihood of Streptococcus as the causative organism in children over 3 years of age and adults. The score was found to have better utility than the Centor score at lower levels and helps screen those patients who would forgo antibiotic treatment.


FiverPAIN Score Interpretation

FeverPAIN score Percent isolation of streptococcus Management
0 13-18% Unlikely streptococcal infection; antibiotics not recommended.
1 14-18%
2 30-35% Consider delayed antibiotics
3 39-48%
4 - 5 62-65% Consider antibiotics if symptoms are severe

1Fever in past 24 hours
2Absence of cough or coryza
3Symptom onset ≤3 days
4Purulent tonsils
5Severe tonsil inflammation
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FeverPAIN score explained

It is clinically important to discern whether the strep throat patient’s pharyngitis is caused by a viral (most cases) or bacterial agent (streptococcal infections with Group A, Group C or G).

The FeverPAIN predicts the likelihood of Streptococcus as the causative organism in children over 3 years of age and adults. The score was found to have better utility than the Centor score at lower levels and helps screen those patients who would forgo antibiotic treatment.

The five criteria are:

  • Fever in past 24 hours;
  • Absence of cough or coryza;
  • Symptom onset ≤3 days;
  • Purulent tonsils;
  • Severe tonsil inflammation.

Lower FeverPAIN scores suggest that streptococcal infection is unlikely, whilst high scores accompanied by severe symptoms will likely require antibiotics.

FeverPAIN score Percent isolation of streptococcus Management
0 13-18% Unlikely streptococcal infection; antibiotics not recommended.
1 14-18%
2 30-35% Consider delayed antibiotics
3 39-48%
4 - 5 62-65% Consider antibiotics if symptoms are severe

The original study cohort consisted in 1760 adults and children aged 3 and over. Three prescribing strategies were compared:

  • Empirical delayed prescribing;
  • Use of the score to direct prescribing;
  • Combination of the score with use of a near patient test (NPT) for streptococcus.

Diagnostic studies showed that 63% of those with scores of 4 or higher had a streptococcal infection. The addition of the NPT did not confer additional benefit.

The application of the score in an implementation study by Little et al. found that antibiotic use was safely reduced by 30%.

An alternative screening method is the Centor score, which helps diagnose streptococcal pharyingitis in children and adults based on clinical data.

 

References

Original references

Little P, et al. Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study. Br J Gen Pract. 2012; 62(604):e787-94.

Little P, Hobbs FDR, Moore M, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ: British Medical Journal. 2013; 347:f5806.

Validation

Little P, et al. PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A β-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat. BMJ Open. 2013; 3(10):e003943.

Little P, PRISM investigators, et. al. PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study. Health Technol Assess. 2014; 18(6):vii-xxv, 1-101.

Other references

Flynn M, Hooper G. Antimicrobial stewardship though FeverPAIN score: Successes and challenges in secondary care. Clinical Infection in Practice. Available online 5 April 2020, 100024.


Specialty: Otolaryngology

Year Of Study: 2012

Article By: Denise Nedea

Published On: July 7, 2020

Last Checked: July 7, 2020

Next Review: July 7, 2025