Akut eksüdati̇f tonsi̇lli̇tli̇ çocuklarda kli̇ni̇k skorlama si̇stemleri̇ni̇n karşilaştirilmasi

Introduction and purpose: Acute exudative tonsillitis is one of the most common upper respiratory tract infections in childhood. The most frequent bacterial cause is Group A β-hemolytic streptococci (GABHS). Its important to diagnose and treat GABHS, because non-suppurative complications like acute rheumatic fever can be prevented. In this study, it was aimed to compare clinical scoring systems that can be used in exudative tonsillopharyngitis and to determine whether these clinical scoring systems could be used in low-resources settings. Materials and Methods: In this study, patients aged between 2 to 16 years, who are admitted to Zonguldak Bulent Ecevit University School of Medicine and Pediatrics and Pediatric Emergency Medicine Departments, were included and among total of 207 patients with exudative tonsilopharyngitis, rapid strep test and throat culture taken. White blood cells, Absolute Neutrophil Count (ANS) and C-Reactive Protein (CRP) were analyzed in all patients and were filled out clinical questionnaires. GABHS and non- GABHS tonsillopharyngitis patients were compared with each other in terms of these parameters. Results: In our study, 32 (%15.4) of the 207 acute exudative tonsillopharyngitis patients who received throat culture and rapid strep antigen tests were GABHS positive. In 175 (%84.6) patients, normal throat flora was detected. The mean age of 32 patients with GABHS positive was 7.09 ±2.40, the mean age of the 175 GABHS negative patients was 6.91 ±3.19 (p=0.348). The ages of our patients were betwen 2 and 16 years old, 101 of them was girls and 106 of them was boys. Complaints of our patients were sore throat (%75.4), cough (%59.9), bad breath (%56.5) and nasal symptoms (nasal discharge and congestion) (%51.7) respectively. Comparison of scoring sistems showed; there was no statistical significant difference between scoring sistems in finding GABHS pharingitis. The white blood cells counts of those who are positive for GABHS is 15.620 cells/mm3 (µL) (5.350-30.610), white blood cells counts of GABHS negative was 11.779 cells/mm3 (µL) (4.400-30.600)'dir (p<0.001). Mean CRP value of GABHS positive was 56.91 mg/l (4.0-171.80). Mean CRP value of GABHS negative was 42.62 mg/l (0.1-265) (p<0.001). The sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value), positive LR (likelihood ratio) and negative LR for Rapid Strep test were %82.7, %97.3, %88.9, %95.7, 30.6, and 0.17 respectively (p<0.001). Conclusion: In our study, we concluded that, scoring systems has no value for finding positive GABHS tonsillopharyngitis. However, negative or low risk scores are meaningful for finding negative GABHS tonsillopharyngitis. In cases where rapid strep test and throat cultures can not be performed, low values detected in scoring sistems may reduce the use of antibiotics. Rapid strep test may decrease the incidence of inappropiate antibiotic use. It should be used nationwide. Key Words: Acute exudative tonsillitis, Streptococcus, Rapid strep test, Throat culture, Clinical Scoring System.