Modified Centor / McIsaac Score
Estimates likelihood of group A streptococcal pharyngitis to guide testing and antibiotic decisions
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Care settings
- Emergency department, Outpatient
Calculate
Answer every item. The result uses the same scoring code Scribeable runs in notes. Nothing you enter leaves this page.
Tonsillar swelling or exudate
Tender or swollen anterior cervical nodes
Temperature above 38°C (100.4°F)
Cough absent
3 to 120 years.
Enter the values above to see the result.
When it activates
Scribeable activates a calculator from the encounter. The Modified Centor / McIsaac Score can activate when the transcript or pasted chart context documents any of these:
- Sore throat evaluation
- Pharyngitis workup
- Suspected strep throat
- Tonsillitis assessment
- Antibiotic decision for pharyngitis
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: J02, J03.
Inputs the note needs
5 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Tonsillar swelling or exudates | exam | Tonsillar swelling or exudates present (Centor: 1 point). | |
| Tender/swollen anterior cervical lymphadenopathy | exam | Tender or swollen anterior cervical lymph nodes (Centor: 1 point). | |
| History of fever (temperature ≥38°C / ≥100.4°F) | vital | ||
| Absence of cough | symptom | Cough is ABSENT (Centor: 1 point — score when there is no cough). | |
| Patient age (for McIsaac modification: 3-14 +1, 15-44 0, ≥45 -1) | age | years | McIsaac age adjustment: +1 if 3–14, 0 if 15–44, −1 if 45 or older. |
Scoring
Tonsillar exudates (+1), Tender anterior cervical lymphadenopathy (+1), Fever history ≥38°C / ≥100.4°F (+1), Absence of cough (+1), Age 3-14 (+1), Age 15-44 (0), Age ≥45 (-1). Range: -1 to 5.
Interpretation
Score 0-1: Low risk (~1-10% GAS), no testing or antibiotics needed. Score 2-3: Moderate risk (~11-35%), perform rapid antigen detection test (RADT). Score 4-5: High risk (~51-53%), consider empiric antibiotics or confirm with RADT.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: McIsaac WJ et al. 1998/2004.
- McIsaac WJ et al. A clinical score to reduce unnecessary antibiotic use in patients with sore throatMcIsaac et al. 2004 · 2004 · Level I · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Modified Centor / McIsaac Score at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Modified Centor / McIsaac Score value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
See it activate on your own encounter
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