Abdominal pain and nausea in the diagnosis of streptococcal pharyngitis in boys

Figures & data

Table 1 Baseline characteristics of all patients with fever and characteristics according to patient sex

	Boys	Girls	Total
Number of patients	3,097	2,658	5,755
Mean age (years) (interquartile range)	4.3 (1–6)	4.4 (1–6)	4.3 (1–6)
Symptoms other than fever
Cough	1,999 (64.5)	1,589 (59.8)	3,588 (62.3)
Sneezing/nasal congestion	1,723 (55.6)	1,314 (49.4)	3,037 (52.8)
Sore throat	424 (13.7)	419 (15.8)	843 (14.6)
Diarrhea	357 (11.5)	227 (8.5)	584 (10.1)
Vomiting	296 (9.6)	262 (9.9)	558 (9.7)
Localized rash	285 (9.2)	212 (8.0)	497 (8.6)
Headache	277 (8.9)	197 (7.4)	474 (8.2)
Generalized rash	199 (6.4)	146 (5.5)	345 (6.0)
Abdominal pain	132 (4.3)	135 (5.1)	267 (4.6)
Eye discharge	101 (3.3)		161 (2.8)
Ear pain/earache		69 (2.6)

Notes: Numbers include patients with clinical diagnosis of probable Group A streptococcal pharyngitis. Symptoms present in >2.5% of patients are shown. Data are presented as the number (%) of patients unless otherwise specified.

Table 2 Final diagnoses of all patients with fever and diagnoses according to patient sex

	Boys	Girls	Total
Number of patients	3,097	2,658	5,755
GAS pharyngitis	185 (6.0)	146 (5.5)	331 (5.8)
Rapid-test-confirmed GAS pharyngitis	122 (65.9)	96 (65.8)	218 (65.9)
Clinical diagnosis of probable GAS pharyngitis	63 (34.1)	50 (34.2)	113 (34.1)
Diagnoses other than GAS pharyngitis
Upper respiratory infection, acute	1,631 (52.7)	1,422 (53.5)	3,053 (53.0)
Fever	477 (15.4)	353 (13.3)	830 (14.4)
Influenza	442 (14.3)	379 (14.3)	821 (14.3)
Acute otitis media/myringitis	329 (10.6)	209 (7.9)	538 (9.3)
Gastroenteritis presumed infection	216 (7.0)	172 (6.5)	388 (6.7)
Acute bronchitis/bronchiolitis	205 (6.6)	155 (5.8)	360 (6.3)
Tonsillitis, acute	99 (3.2)	88 (3.3)	187 (3.2)
Sneezing/nasal congestion	109 (3.5)	75 (2.8)	184 (3.2)
Diarrhea	91 (2.9)	73 (2.7)	164 (2.8)
Cough	82 (2.6)

Notes: Numbers include patients with clinical diagnosis of probable GAS pharyngitis. Diagnoses present in >2.5% of patients are shown. Data are presented as the number (%) of patients.

Abbreviation: GAS, Group A streptococcus.

Table 3 Frequency of rapid-test-confirmed GAS pharyngitis in boys and girls with fever

	Symptoms
	Fever + Abdominal pain	Fever + Nausea	Fever + Vomiting	Fever
Boys	11/120 (9.2)	7/68 (10.3)	11/269 (4.1)	122/3,034 (4.0)
Girls	3/128 (2.3)	2/50 (4.0)	9/240 (3.8)	96/2,608 (3.7)
Total	14/248 (5.6)	9/118 (7.6)	20/509 (3.9)	218/5,642 (3.9)
p-valuesa	0.026	0.30	1.0	0.53

Notes: Patients with clinical diagnosis of probable GAS pharyngitis were excluded from the analysis. Data are presented as the number/total number (%) of patients unless otherwise specified.

a Differences between boys and girls by Fisher’s exact test.

Abbreviation: GAS, Group A streptococcus.

Table 4 Diagnostic accuracy of gastrointestinal symptoms in predicting GAS pharyngitis in boys and girls with fever

		Positive LR (95% CI)	Negative LR (95% CI)	Sensitivity (95% CI)	Specificity (95% CI)
Abdominal pain	Boys	2.41 (1.33–4.36)	0.95 (0.89–1.00)	0.09 (0.05–0.16)	0.96 (0.96–0.97)
	Girls	0.63 (0.20–1.94)	1.02 (0.98–1.06)	0.03 (0.01–0.09)	0.95 (0.94–0.96)
	Total	1.49 (0.88–2.51)	0.98 (0.94–1.01)	0.06 (0.04–0.11)	0.96 (0.95–0.96)
Nausea	Boys	2.74 (1.28–5.86)	0.96 (0.92–1.01)	0.06 (0.02–0.12)	0.98 (0.97–0.98)
	Girls	1.09 (0.27–4.42)	1.00 (0.97–1.03)	0.02 (0.00–0.07)	0.98 (0.98–0.99)
	Total	2.05 (1.06–4.00)	0.98 (0.95–1.01)	0.04 (0.02–0.08)	0.98 (0.98–0.98)
Vomiting	Boys	1.02 (0.57–1.81)	1.00 (0.94–1.06)	0.09 (0.05–0.16)	0.91 (0.90–0.92)
	Girls	1.02 (0.54–1.92)	1.00 (0.94–1.07)	0.09 (0.04–0.17)	0.91 (0.90–0.92)
	Total	1.02 (0.67–1.56)	1.00 (0.96–1.04)	0.09 (0.06–0.14)	0.91 (0.90–0.92)

Note: Patients with clinical diagnosis of probable GAS pharyngitis were excluded from the analysis.

Abbreviations: GAS, Group A streptococcus; LR, likelihood ratio.

Table 5 Frequency of gastrointestinal symptoms in boys and girls with fever diagnosed with GAS pharyngitis by rapid tests versus those clinically diagnosed with probable GAS pharyngitis

		Rapid-test-confirmed GAS pharyngitis	Clinical diagnosis of probable GAS pharyngitis
Abdominal pain	Boys	11/122 (9.0)	6/63 (9.5)
	Girls	3/96 (3.1)	2/50 (4.0)
	Total	14/218 (6.4)	8/113 (7.1)
Nausea	Boys	7/122 (5.7)	1/63 (1.6)
	Girls	2/96 (2.1)	0/50 (0.0)
	Total	9/218 (4.1)	1/113 (0.9)
Vomiting	Boys	11/122 (9.0)	9/63 (14.3)
	Girls	9/96 (9.4)	4/50 (8.0)
	Total	20/218 (9.2)	13/113 (11.5)

Note: Data are presented as the number/total number (%) of patients.

Abbreviation: GAS, Group A streptococcus.