Avoiding Sore Throat Morbidity and Mortality: When Is It Not 'Just a Sore Throat?'

摘要

Sore throat consistently ranks in the top 10 reasons for ambulatory care visits. We see this symptom so often that our vocabulary even includes the phrase "just a sore throat." For more than 50 years, physicians have considered group A beta-hemolytic streptococcus the only important cause of sore throat, because it can lead to acute rheumatic fever. Although we know that other organisms can also cause sore throat, disease management guidelines ignore them because experts believe those organisms cause self-limited symptoms without serious sequelae.These guidelines have driven many physicians to use algorithms for sore throat management, which has resulted in many offices, urgent care centers, and emergency departments using programmed evaluation and management strategies for patients with sore throat. Often, the rapid strep test is ordered routinely for patients with sore throat, rather than basing the decision to test on a targeted history and physical examination. This strategy results in patients being diagnosed as having or not having strep throat, which implies that antibiotics are not needed if the patient does not have strep throat.