Clinical scoring systems
Using clinical scoring systems
Information gathering for sore throat will include three elements:
- The pharmacist’s usual questioning
- Palpation of the neck
- Examining the appearance of the throat.
These last two actions enable the use of a clinical scoring system to assess the likelihood of bacterial infection. The use of clinical scoring systems is recommended by NICE. Pharmacy First PGDs refer to FeverPAIN. Higher scores suggest more severe symptoms and a likely bacterial (streptococcal) cause. NICE makes recommendations on when antibiotics might be of benefit.
Sore throats are often associated with other symptoms of a cold, and determining whether cold symptoms, particularly a cough, are present is a useful way to triage cases.
A cold makes a throat infection less likely as a viral cause is more probable.
Use the FeverPAIN scoring system to determine next steps:
- Score 0 or 1: offer self-care advice and pain relief
- Score 2 or 3: offer self-care advice and pain relief
- Score 4 or 5: Gateway Point
If the Gateway Point in the clinical pathway is reached:
- For mild symptoms consider pain relief and self-care as first-line treatment. Ask the patient to return to the pharmacy if there is no improvement in 3-5 days for reassessment
- For severe symptoms consider offering an antibiotic using a PGD.