Views & Reviews From the Frontline

Bad medicine: NICE’s traffic light system for febrile children

BMJ 2014; 348 doi: (Published 11 March 2014) Cite this as: BMJ 2014;348:g2056
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

The Centor criteria are used to diagnose bacterial tonsillitis. As a sceptic I always thought them flawed. The carriage of Streptococcus is so common, at 30-40%, that it makes the criteria’s predictive power meaningless. Also, the use of antibiotics has a limited effect on bacterial complications in rich countries.1

I was taught Centor in the traditional, absolutist medical way. Clinical rating scores are intellectually seductive, but do they stand up to scrutiny? Recent research has shown that the criteria may be ineffective in children and adolescents in predicting the presence of Streptococcus.2

The UK …

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