FeverPAIN

FeverPAIN is a clinical scoring system used to assess acute sore throat and estimate the likelihood that symptoms are due to group A streptococcus (GAS) infection, with the goal of guiding antibiotic prescribing. It is intended to supplement clinical judgment, not replace it, and is commonly used in primary care settings.

The score consists of five criteria, each contributing one point if present: Fever in the last 24 hours; Purulence (pus) on the tonsils; Attend (present for care) within 3 days of onset of symptoms; Inflamed tonsils; No cough or coryza. The total score ranges from 0 to 5.

Interpretation generally follows these rough guidelines: a score of 0–1 indicates a low probability of GAS and antibiotics are usually not recommended; a score of 2–3 suggests intermediate probability and may prompt a throat swab, rapid test, or a delayed/alternative management approach depending on local guidelines; a score of 4–5 indicates a high probability of GAS and antibiotics may be considered, in line with local recommendations. In many systems the decision to treat also incorporates patient factors and local resistance patterns.

Limitations include variations in performance across populations and age groups, and it should not be used as the sole basis for diagnosis or management. FeverPAIN is often used alongside other criteria or tests, and recommendations can differ by country and guideline.