8/13/19 1 VIRAL PHARYNGITIS: IMPROVED DIAGNOSIS WITH THE CENTOR CRITERIA Dr. Monica Denning-Maldonado, APRN, FNP-C Objectives • Description of the clinical problem • Review of Literature • Explain theoretical framework adapted • Explain Quality Improvement Model adapted • Discuss findings and outcomes • Implications for Nursing Practice Clinical Reflective Journal Conclusions Journal • Most Common complaint • Diagnosis • Returned visits • Overuse of strep tests • No evidence-based guidelines https://www.insidehighered.com/advice/2016/0 4/21/advice-getting-published-scholarly-journal- essay Viral Pharyngitis Introduction Pharyngitis • Difficult • Led to issues: • Antibiotic overuse • Side effects • Increased costs • Antibiotic resistance https://healthool.com/sore-throat-on-one- side/ Antibiotic Overuse Centers for Disease Control and Prevention On a global scale, WHO (2014) states: • Antibiotic resistance is serious threat to global public health World Health Organization • 2 million people affected by antibiotic resistant infections • Associated with 23,000 US deaths annually (CDC, 2013) • Pharyngitis leading Dx with 40% of unnecessary antibiotic Rx (Fiore, Fettic, Wright, & Ferrara, 2018) https://www.youtube.com/ watch?v=SyxoAO6avFs Antibiotic Expenditures https://www.alternet.org/economy/pill- cures-hepatitis-costs-just-4-if-you-live- america-its-1000 • 2010-2015 US antibiotic expenditures $56 billion • One solution (Suda et al., 2018)
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8/13/19
1
VIRAL PHARYNGITIS: IMPROVED DIAGNOSIS WITH
THE CENTOR CRITERIA
Dr. Monica Denning-Maldonado, APRN, FNP-C
Objectives
• Description of the clinical problem• Review of Literature• Explain theoretical framework adapted• Explain Quality Improvement Model
adapted • Discuss findings and outcomes• Implications for Nursing Practice
• Adds a criteria for age• Aged 3-14 add 1 point• Aged 45 or older subtract 1
point• Validated
• McIsaac, White, Tannenbaum, & Baum, 1998
• McIsaac, Goel, To, & Low, 2000
• Fine, Nizet, & Mandl, in 2012• 3 years or older
McIsaac Score, Modified Centor Score
• Group A Streptococcal (GAS) from viral pharyngitis
• Sensitivity for identifying GAS infection
• 83.1% of the time compared to 69.4% usual care
• Validated:• Centor, Witherspoon, Dalton,
Brody, & Link, 1981• Fine, Nizet, & Mandl, in 2012
• 15 years or older
Centor Criteria
Criteria Score
Temperature above 100.4 1
Absence of cough
(as cough is more likely to be associated
with a viral infection)
1
Swollen or tender anterior cervical
lymph nodes
1
Tonsillar swelling or exudates 1
(Centor Criteria adapted for Presentation by M. Denning-Maldonado, 2018)
Literature Review
Hildreth, A. F., Takhar, S., Clark, M. A., & Hatten, B. (2015). Evidence-Based Evaluation And Management Of Patients With Pharyngitis In The Emergency Department. Emergency Medicine Practice, 17(9), 1-16.
Theoretical Framework
Lewin’s Change Theory
Kaminski, J. (Winter, 2011). Theory applied to informatics – Lewin’s Change Theory. CJNI: Canadian Journal of Nursing Informatics, 6 (1), Editorial. http://cjni.net/journal/?p=1210
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FADE MODELFocus
• Clinical Reflective Journal
Analyze• Literature
Review
Develop• Capstone Project
designed
Execute/ Evaluate
• Capstone Project implemented
• Evaluate data
(FADE Model adapted for Presentation by M. Denning-Maldonado, 2018)
• Implement diagnostic tool
• No antibiotic given for Centor Score of 0 or 1
• Symptomatic treatment only
• Quality care measures improved http://www.vacms.org/page-18086
(Martinez, et al., 2018) https://www.fdiworlddental.org/news/20171117/fdi-continues-to-represent-the-profession-at-global-event-on-antimicrobial-resistance
Conclusion
• Transform Care
• Patients wants
• Provider approach
• Best practice
• Quality patient care http://www.ebnhealth.com/index.php/how-we-can-help/best-practice-guidelines-and-drug-information
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ReferencesAustin, T., & Jarvis, C. (1998). How to save time, money, and a precious resource via CQI.
MLO: Medical Laboratory Observer, 30(1), 50.Centers for Disease Control and Prevention. Antibiotic resistance threats in the United
States, 2013. http://www.cdc.gov/drugresistance/threat -report-2013/. Accessed March 5, 2018.
Centor, R. M., Witherspoon, J. M., Dalton, H. P., Brody, C. E., & Link, K. (1981). The diagnosis of strep throat in adults in the emergency room. Medical Decision Making: An International Journal Of The Society For Medical Decision Making, 1(3), 239-246.
Fiore, D. C., Fettic, L. P., Wright, S. D., & Ferrara, B. R. (2018). Antibiotic Overprescribing Still a Major Concern: Antibiotic overuse has far-reaching effects on patients' general
health, as well as possible connections to HIV, diabetes, and obesity. Clinician Reviews (pp. 22-32). Frontline Medical Communications.Fine, A. M., Nizet, V., & Mandl, K. D. (2012). Large-scale validation of the Centor and
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Management Of Patients With Pharyngitis In The Emergency Department. Emergency Medicine Practice, 17(9), 1-16.
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Martinez, K. A., Rood, M., Jhangiani N., Boissy, A., & Rothberg, M. B., (2018). Antibiotic prescribing for respiratory tract infections and encounter length: An observational study of telemedicine. Annals of Internal Medicine, 17(4), 257-277.
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Suda, K. J., Hicks, L. A., Roberts, R. M., Hunkler, R. J., Matusiak, L. M., & Schumock, G. T., (2010). Antibiotic Expenditures by Medication, Class, and Healthcare Setting in the United States, 2010–2015, Clinical Infectious Diseases, 66(2), 185–190.
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