Upper Respiratory Tract Protocol

To the Editor.  —The presentation of an upper-respiratory tract complaint protocol by Greenfield et al (Arch Intern Med 133:294-299) and the result achieved with the use of this protocol were impressive from the standpoint of the organization of the data collection form and the decision-making algorithm; however, two additional interpretations of their results deserve mention. Although the statement is made that the protocol manifested equal or better judgement compared to the physicians, an examination of their results showed that, under the protocol's disposition, 22 patients would have received penicillin, seven of whom were shown to have positive throat cultures for group A β-hemolytic streptococci. This is a treatment accuracy of 32% as compared to the physicians' 25% accuracy, probably an insignificant difference. More important however, is the fact that the accuracy was only 32% and, taking into account that an additional four patients who did not receive penicillin under the