Maryam Razavi

maryam.razavi@cambio.se

CambioCDS

To help clinicians identify which patients with a recurring sore throat will benefit from tonsillectomy.

Use only in patients aged 1-18 years in whom tonsillectomy is being considered. Variable and assigned points (No=0, Yes=1): -Sore throat episodes: ≥7 episodes in the preceding year, ≥5 episodes in each of the preceding 2 years, ≥3 episodes in each of the preceding 3 years - Clinical features (sore throat plus ≥1 feature qualifies as an episode): Temperature >38.3°C (100.9°F), Cervical lymphadenopathy (tender or enlarged (>2 cm) lymph nodes), Tonsillar or pharyngeal exudate, Positive culture for group A β-hemolytic streptococcus. - Treatment: Antibiotics had been administered in conventional dosage for proven or suspected streptococcal episodes. Documentation: Each episode and qualifying features documented, If not fully documented, subsequent observance by the clinician of 2 episodes of throat infection with patterns of frequency and clinical features consistent with initial history. Paradise Criteria= Selection of the appropriate variables (all 4 variables must be fulfilled by at least one option). If the score of any variable is <1, patient does not meet Paradise Criteria.

Not to use in children with diabetes mellitus, cardiopulmonary disease, craniofacial disorders, congenital anomalies of the head/neck, sickle cell disease or other coagulopathies, or immunodeficiency disorders. Not to be used if symptoms occurred over the course of <12 months, as the efficacy of tonsillectomy in this situation has not been studied and some children may have spontaneous resolution.

1. Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984;310(11):674-83. 2. Burton MJ, Glasziou PP, Chong LY, Venekamp RP. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2014;(11):CD001802. 3. Morad A, Sathe NA, Francis DO, Mcpheeters ML, Chinnadurai S. Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review. Pediatrics. 2017;139(2). 4. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144(1 Suppl):S1-30. 5. Paradise JL, Bluestone CD, Bachman RZ, et al. History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented. N Engl J Med. 1978;298(8):409-13. 6. Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-lasky M. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics. 2002;110(1 Pt 1):7-15. 7. Randel A. AAO-HNS Guidelines for Tonsillectomy in Children and Adolescents. Am Fam Physician. 2011;84(5):566-73.

OBSERVATION.paradise_criteria.v0