OBJECTIVE: History, clinical examination and throat culture may be inadequate to 
rule in or out the presence of group A streptococci (GAS) infection in patients 
with sore throat in a remote location. We correlated the diagnostic accuracy for 
guiding antibiotic prescription of clinical decision and physiological scoring 
systems to a rapid diagnostic point of care (POC) test result in paediatric 
patients presenting with sore throat.
METHODS: Prospective diagnostic accuracy study conducted between 30 June 2014 
and 27 February 2015 in a remote Australian ED using a convenience sample. Among 
paediatric patients presenting with sore throat, the Centor criteria and 
clinical decision were documented. Simultaneously, patients without sore throat 
or respiratory tract infection were tested to determine the number of carriers. 
A throat swab on all patients was tested using a POC test (Alere TestPack +Plus 
Strep A with on board control), considered as reference standard to detect GAS 
infection.
RESULTS: A total of 101 patients with sore throat were tested with 26 (25.7%) 
positive for GAS. One hundred and forty-seven patients without sore throat were 
tested with one positive POC test result (specificity 99%; 95% CI 96-100). 
Positive predictive value for clinician decision-making for a positive GAS swab 
(bacterial infection) was 29% (95% CI 17-43), negative predictive value 78% (95% 
CI 63-88). Area under ROC for the Centor score was 0.70 (95% CI 0.58-0.81).
CONCLUSION: Clinician judgement and Centor score are inadequate tools for 
clinical decision-making for children presenting with sore throat. Adjunctive 
POC testing provides sufficient accuracy to guide antibiotic prescription on 
first presentation.