Symptoms and signs:

Using clinical scoring systems

Pharmacy information gathering for sore throat will include three elements: the pharmacist’s usual questioning, plus palpation of the neck and examining the appearance of the throat. The latter two enable use of a clinical scoring system to assess the likelihood of bacterial infection.

The use of clinical scoring systems is recommended by NICE using either FeverPAIN (specified in the Pharmacy First service) or CENTOR. Higher scores suggest more severe symptoms and a likely bacterial (streptococcal) cause. NICE makes recommendations on when antibiotics might be of benefit (see table online).

Sore throats are often associated with other symptoms of a cold. Determining whether cold symptoms, particularly cough, are present is a useful way to triage cases (bacterial throat infection less likely as viral cause more likely).

Examining the patient

An important part of assessing a patient with a sore throat is to see if there are signs of the patient appearing unwell or having symptoms of a respiratory tract infection, with coughing or a running nose. It is also good practice to check for raised temperature, ideally using an ear thermometer.
The pharmacist will need to examine the patient’s throat and neck in order to use a clinical scoring system. See image at the start of the module for the anatomy seen during a throat examination.

Before the examination the patient should be asked if it is OK to examine them (seeking consent) and, of course, hand washing is required. The examination requires a good light source (e.g. pen torch). This is best done with the patient seated alongside the pharmacist. Asking the patient to say “ahh” helps to raise the soft palate and lower the tongue, and allows a better view of the back of the throat.

Using a tongue depressor (large ‘lollipop’ stick) may help to avoid the tongue getting in the way. Examine the tonsils to see if they are red or swollen and if there is any exudate or signs of ulceration. Examine the back of the throat (beyond the soft palate and aside from the tonsils) to see if it is red or inflamed. 

There are numerous examples of how to do this on YouTube. The neck should also be examined to see if there are enlarged lymph glands and whether these are tender.

The neck is best examined standing behind the patient. A good example of this examination is from the same series on Youtube. The main thing to look for with sore throat is whether the anterior cervical glands are swollen and/or tender. See the CPPE’s clinical examination assessment record checklist for the throat examination process.