Yes, Both Tonsillitis and Pharyngitis Use the Same Centor Scoring System
The Centor score is applied to acute sore throat presentations regardless of whether the inflammation primarily involves the tonsils (tonsillitis) or the pharynx (pharyngitis), as both conditions are part of the same clinical spectrum of group A streptococcal infection. 1
Why the Same Scoring System Applies
The Centor criteria were developed to assess the likelihood of group A streptococcal infection in patients presenting with acute sore throat, which encompasses both pharyngitis and tonsillitis as overlapping clinical presentations. 2, 3 The guideline literature consistently refers to "acute sore throat," "pharyngitis," and "tonsillitis" interchangeably when discussing the Centor score application. 1
In fact, one of the four Centor criteria specifically evaluates tonsillar exudate, demonstrating that tonsillitis is inherently incorporated into the scoring system. 2, 3 The four components are:
- Fever by history (1 point) 2
- Tonsillar exudates (1 point) 2
- Tender anterior cervical lymphadenopathy (1 point) 2
- Absence of cough (1 point) 2
Clinical Application
The European guideline for acute sore throat management explicitly states that the Centor score helps identify patients with higher likelihood of group A streptococcal infection, whether presenting with pharyngitis or tonsillitis. 1 A German guideline on tonsillitis specifically recommends using the Centor or McIsaac scoring system to estimate the probability of β-hemolytic streptococcal tonsillitis. 4
Risk Stratification Remains Identical
The risk stratification based on Centor score applies equally to both conditions:
- Score 0-2: Low probability (1-17% risk of GAS), no testing or antibiotics recommended 2, 3
- Score 3-4: Higher probability (28-53% risk of GAS), consider rapid antigen testing 2, 3
Important Clinical Caveat
The Centor score was validated only in adults, not children, so its utility is lower in pediatric populations regardless of whether the presentation is labeled as pharyngitis or tonsillitis. 2 The modified McIsaac score adds age stratification for broader applicability across age groups. 3