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FeverPAIN Score

Streptococcal pharyngitis likelihood - used in NICE sore-throat guidance.

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1 What is the FeverPAIN Score?

The FeverPAIN Score is a infectious scoring tool used in paediatric practice. Streptococcal pharyngitis likelihood - used in NICE sore-throat guidance. It scores 5 criteria and interprets the total across 3 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in infectious
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 5 criteria: Fever in the past 24 hours; Purulence (pus on tonsils); Attended rapidly - symptoms ≤3 days before presentation; Severely Inflamed tonsils; No cough or coryza. Totals are then banded: any score - Low (13-18 %): score 0-1 - 13-18% streptococcal likelihood. Antibiotics not indicated; give self-care advice; 2 points or more - Intermediate (34-40 %): score 2-3 - 34-40% likelihood. Consider a delayed ("back-up") antibiotic prescription; 4 points or more - High (62-65 %): score 4-5 - 62-65% likelihood. Consider immediate antibiotics if severely unwell.
  • Source: Little P et al. PRISM study - clinical score and rapid antigen detection test to guide antibiotic use for sore throats. BMJ 2013;347:f5806. Adopted in NICE NG84.

4 Frequently asked questions

How many criteria does the FeverPAIN Score use?

5. They are Fever in the past 24 hours; Purulence (pus on tonsils); Attended rapidly - symptoms ≤3 days before presentation; Severely Inflamed tonsils; No cough or coryza.

What do the bands of the FeverPAIN Score mean?

The total is interpreted as: any score - Low (13-18 %): score 0-1 - 13-18% streptococcal likelihood. Antibiotics not indicated; give self-care advice; 2 points or more - Intermediate (34-40 %): score 2-3 - 34-40% likelihood. Consider a delayed ("back-up") antibiotic prescription; 4 points or more - High (62-65 %): score 4-5 - 62-65% likelihood. Consider immediate antibiotics if severely unwell.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Source: Little P et al. PRISM study - clinical score and rapid antigen detection test to guide antibiotic use for sore throats. BMJ 2013;347:f5806. Adopted in NICE NG84.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

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For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.