Methodological quality of the selected studies that derived or validated clinical decision rules for the diagnosis of GAS pharyngitis in children
| Quality criteria3738 | Breese25 | Funamura26 | Karacan*27 | Centor†19 | Dagnelie28 | Hall29 | WHO†20 | Steinhoff 30 | Rimoin31 | McIsaac†21 | McIsaac32 | McIsaac33 | Edmonson34 | Tanz35 | Attia†22 | Attia36 | Smeesters†23 | Joachim†24 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Children/total population | 670/670 | 892/892 | 857/857 | 0/234 | 79/558 | 561/561 | MD | 451/451 | 1810/1810 | 90/521 | 167/620 | 454/787 | 1184/1184 | 1848/1848 | 297/297 | 587/587 | 220/220 | 356/356 |
| Outcome | ||||||||||||||||||
| GAS pharyngitis | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Culture | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 0 |
| Culture described | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Blind assessment | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Variables | ||||||||||||||||||
| Defined | NC | NC | NC | 0 | NC | NC | 0 | NC | NC | 0 | NC | NC | NC | NC | 0 | NC | 0 | 0 |
| Choice explained | NC | NC | NC | 0 | NC | NC | 0 | NC | NC | 0 | NC | NC | NC | NC | 0 | NC | 1 | 1 |
| Important variables | NC | NC | NC | 1 | NC | NC | 0 | NC | NC | 1 | NC | NC | NC | NC | 1 | NC | 0 | 0 |
| Same variables | 0 | 0 | 0 | NC | 0 | 0 | NC | 0 | 1 | NC | 0 | 1 | 1 | 1 | NC | 0 | NC | NC |
| Blind assessment | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | |
| Patients’ characteristics | ||||||||||||||||||
| Age (years) | MD | 0–16 | MD | >15 | 4–14 | 2–17 | MD | 2–13 | 2–12 | 3–14 | 3–14 | 3–17 | MD | 3–18 | 0.5–18 | MD | 0–15 | 0–15 |
| Mean/median age | MD | MD | 5.6 | MD | ‡ | 9 | MD | MD | 5.1 | ‡ | MD | ‡ | 8.41§ | 9.3 | 6.2 | 6.8 | 6.6 | 5.4 |
| Sex ratio | MD | MD | 1.2 | MD | MD | 0.9 | MD | 1.1 | 1.3 | ‡ | ‡ | MD | 0.9 | 0.9 | 1.1 | 1.0 | 1.3 | 1.1 |
| Prevalence GAS (%) | 54 | 28 | 49 | ‡ | 58 | 27 | MD | 24 | 29 | 36 | 35 | 34 | 32 | 30 | 29 | 37 | 26 | 33 |
| Study site | ||||||||||||||||||
| Medical setting | GP | Clinic | Hospital | ED | GP | ED, GP | MD | Hospital | Clinic | GP | GP | GP | Clinic | GP | ED | ED | ED | ED |
| Country | USA | USA | TUR | USA | NL¶ | USA | MD | EG | BR, EG, HR | CA | CA | CA | USA | USA | USA¶ | USA¶ | BR | BR |
| Statistics | ||||||||||||||||||
| Described | NC | NC | NC | 1 | NC | NC | 0 | NC | NC | 1 | NC | NC | NC | NC | 1 | NC | 1 | 1 |
| Logistic regression | NC | NC | NC | 1 | NC | NC | 0 | NC | NC | 1 | NC | NC | NC | NC | 1 | NC | 1 | 0 |
| Outcome/variable | NC | NC | NC | 0 | NC | NC | 0 | NC | NC | 1 | NC | NC | NC | NC | 1 | NC | 0 | 0 |
| Performance described | 0 | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 |
| CDR reproducibility | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
| Development** | 3 | 3 | 3 | 1 | 3 | 3 | 0 | 3 | 3 | 2 | 3 | 3 | 0 | 3 | 1 | 3 | 2 | 2 |
| CDR practical use | ||||||||||||||||||
| Clinically sensible | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Easy to use | 0 | 0 | 0 | 1 | 1 | 1 | 1. | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 |
| Course of action | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Total score | 9†† | 12†† | 13†† | 14† | 13†† | 14†† | 3† | 16†† | 18†† | 20† | 15†† | 16†† | 13†† | 17†† | 16† | 16†† | 17† | 15† |
| N/24† or N/2155 (%) | (43) | (57) | (62) | (58) | (62) | (67) | (13) | (76) | (86) | (83) | (71) | (76) | (62) | (81) | (67) | (76) | (71) | (63) |
Each study present criterion for patient characteristics and medical setting worth one point each.
*Children >3 years old only.
†Derivation studies.
‡Validated, but adult and paediatric data.
§Estimated with the number of children per age group.
¶Not provided in the articles.
** Development of the rule37: derivation study (1 point), internal validation (2 points), external and prospective validation (3 points) and impact of the rule on clinical behaviour (4 points)
††Validation study: 1, validated; 0, not validated, although not specified.
BR, Brazil; Ca, Canada; CDR, clinical decision rule; ED, emergency department; EG, Egypt; GAS, group A streptococcal; GP, general practitioner; HR, Croatia; MD, missing data; NC, not concerned; NL, Netherlands; TUR, Turkey.