Virtual appointments may not be the ideal channel for leveraging the Centor Criteria for tonsillitis, which calls for a clinician to check a patient for fever as well as tender and swollen lymph nodes. A cross-sectional study of 189 patients published in Infectious Diseases, analyzed digital assessments in comparison to physical examinations when used to determine clinical recommendations for treatment of tonsillitis. The study included 3 urgent care clinics and 6 primary care practices in Sweden. Patients were evaluated with both a digital assessment via video and a separate physical examination conducted by a different clinician. Most patients had Centor scores 0-3, and only 9.2% had a Centor score of 4. The authors concluded that virtual examination for patients with an acute sore throat is not reliable for assessing Centor criteria because they observed discrepancies and poor concordance between the in-person assessments and the virtually conducted assessments.
How to use virtual care for tonsillitis: The authors caution that “Potential difficulties faced in telemedicine may lead to diagnostic uncertainty, consequently raising the risk of either overdiagnosis and unnecessary antibiotic treatment or underdiagnosis.” They believe virtual care should only be used as an initial triage tool for tonsillitis.