Patient-clinician agreement on signs and symptoms of 'strep throat': a MetroNet study |
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Authors: | Xu Jinping Schwartz Kendra Monsur Joseph Northrup Justin Neale Anne Victoria |
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Affiliation: | Department of Family Medicine, Wayne State University, Detroit, MI 48201, USA. jxu@med.wayne.edu |
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Abstract: | BACKGROUND: Despite substantial use of the telephone in health care, only a few studies have formally evaluated the appropriateness of telephone-based management for acute medical problems. The accuracy of patients' report of signs and symptoms remains unknown. OBJECTIVE: We compared the agreement between patient self-assessment and clinician assessment on the typical signs and symptoms of group A beta-haemolytic Streptococcus (GABHS) to investigate the potential difficulties of using patient self-report to triage sore throat patients. METHODS: In this cross-sectional study, each of 200 adult pharyngitis patients was instructed to examine him/herself and to record the symptoms and physical findings. Two clinicians independently interviewed and examined each patient and recorded their findings. Each patient then had a rapid GABHS antigen test, the results of which were blinded to both clinicians and patients. Each patient self-assessment was compared with the findings of each clinician, and the agreement and disagreement between them computed. RESULTS: We found varying levels of agreement (kappa=-0.05 to 0.71) between patients and clinicians on sore throat history and physical assessments. Importantly, there was fair to substantial agreement (kappa=0.20-0.71) on the key signs and symptoms used in GABHS clinical prediction rules. As expected, history items had the highest agreement (kappa=0.52-0.71). Patients were more likely than clinicians to report rather than deny a specific physical sign. CONCLUSION: Adult sore throat patients may reliably report their symptoms, but may not be able to assess and report accurately on relevant physical signs of pharyngitis. Patients have a tendency to over-report physical signs. This study indicates the potential difficulties associated with telephone triage of sore throat patients, or other illnesses that require assessment of physical signs. |
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Keywords: | . Group A ß -haemolytic Streptococcus, interobserver agreement, kappa coefficient, pharyngitis, sore throat, telephone triage. |
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