The medical literature suggests that antibiotics are used excessively to treat upper respiratory tract infections because physicians want to minimize the risk of failing to treat patients who would benefit from antibiotic therapy. Thus, the critical issue for the sore throat score is whether a sensitivity of 85% (or a false negative rate of 15%) will make practitioners sufficiently confident in the tool that they will abide by its recommendations.

It would be helpful if McIsaac and colleagues provided data on the percentage of patients who required an antibiotic prescription but did not get one on the basis of physician judgement. If physician judgement had a false negative rate of less than 15% this would imply that the physician threshold for committing an error of undertreatment is too high for physicians to follow the recommendations of the sore throat score.