FeverPAIN Clinical Score

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Public Health England’s management of infection guideline recommends the use of FeverPAIN score in the assessment of acute sore throats.

The score consist of five items:

  • Fever in last 24 hours
  • Purulence
  • Attend rapidly under 3 days
  • Inflamed tonsils
  • No cough or coyza
  • Score 0-1 = 13-18% streptococci, use NO antibiotic strategy
  • Score 2-3 = 34-40% streptococci, use 3 day back-up antibiotic prescription strategy
  • Score ≥4 = 62-65% streptococci, use immediate antibiotic if severe, or 48 hour short back-up prescription

The Fever PAIN score was derived from a cohort study including 1760 adults and children aged 3 and over. The score was tested in a trial comparing three prescribing strategies, empirical delayed prescribing, use of the score to direct prescribing or combination of the score with use of a near patient test (NPT) for streptococcus. Using the score resulted in more rapid symptom resolution and reduced prescribing of antibiotics (both reduced by one third). The addition of the NPT did not confer any additional benefit.

Using the online FeverPAIN score tool enables rapid calculation of the score, gives a treatment guide and provides a summary to cut and paste in the notes.