NEW guideline recommendations highlight how GAS pharyngitis clinical scoring can refine testing decisions in everyday practice.
This first part of the updated clinical practice guideline on diagnosis and management of group A streptococcal pharyngitis focuses on which patients with sore throat should be tested for Streptococcus pyogenes. The guideline panel notes that clinician judgement alone is unreliable for predicting a positive throat culture, and that broad, unselective testing exposes many low-risk patients to avoidable cost and inconvenience.
Why GAS Pharyngitis Clinical Scoring Matters
The guideline examines clinical scoring systems that estimate the probability of confirmed GAS based on standardized bedside findings. These include the presence of fever, tonsillar enlargement or exudate, tender and enlarged anterior cervical lymph nodes, and the absence of cough. By translating these features into a structured score, GAS pharyngitis clinical scoring can help clinicians decide whether to perform a rapid antigen detection test, molecular assay, or throat culture, rather than relying on impression alone.
Evidence Comparing Scoring Systems with Clinician Judgement
To inform the recommendations, the panel conducted a systematic review of randomized and non-randomized studies in children and adults that compared a clinical scoring system with clinician judgement alone for predicting throat culture results. Across settings, the diagnostic accuracy of scoring systems was comparable to, or slightly higher than, clinician judgement. However, the panel emphasizes important limitations, including small sample sizes, inconsistent outcome measures, and incomplete data reporting. Despite these constraints, the consensus view is that the overall balance of benefits and harms supports incorporating a scoring system into the diagnostic pathway.
Applying the Guideline in Children and Adults
The principal utility of clinical scoring systems is to identify patients with a low probability of group A streptococcal infections who are unlikely to benefit from diagnostic testing. In such cases, clinicians may reasonably avoid rapid antigen detection tests, molecular methods, and throat cultures, focusing instead on symptomatic management of sore throat. For patients whose scores indicate intermediate or higher risk, targeted testing can confirm or exclude group A streptococcal pharyngitis and guide subsequent management. As sore throat treatment guidelines evolve, the panel positions clinical scoring as a practical tool that supports more consistent decision making across clinicians and care settings while reducing unnecessary testing for both children and adults.
Reference: Linder J et al. 2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Group A Streptococcal (GAS) Pharyngitis: Risk assessment using clinical scoring systems in children and adults. Clin Infect Dis. 2025;10.1093/cid/ciaf668.
