The Modified Centor criteria (MCC) is a validated clinical decision tool determining the need for testing in suspected Streptococcal pharyngitis. This study aims to understand the use of this tool to guide testing during remote evaluation. Patients with sore throats and no more than 3 days of symptoms were recruited from the emergency department and urgent care at an urban academic centre in 2019–2022. All patients enrolled were 18 years or older. Each participant had three MCC recorded, once in person and again by two different blinded telemedicine providers (TP). A total of 172 patients were screened and 40 were enrolled, they had a mean age 32 and were 43% male. We calculated inter-rater reliability between in-person and telemedicine providers, using a threshold score of strep testing (≥2) and non-testing scores (<2). Cohen’s kappa between in-person and telemedicine providers was 0.68 while the TP were in complete agreement.

Accelerated junctional rhythm has been reported in children in the setting of acute rheumatic fever; however, we describe a hitherto unreported case of isolated junctional tachycardia in a child with streptococcal pharyngitis, not meeting revised Jones criteria for rheumatic fever. A previously healthy, 9-year-old girl presented to the emergency department with complaints of sore throat, low-grade fever, and intermittent chest pain. She was found to have a positive rapid streptococcal antigen test. The initial electrocardiogram showed junctional tachycardia with atrioventricular dissociation in addition to prolonged and aberrant atrioventricular conduction. An echocardiogram revealed normal cardiac anatomy with normal biventricular function. The patient responded to treatment with amoxicillin for streptococcal pharyngitis. The junctional tachycardia and other electrocardiogram abnormalities resolved during follow-up.