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Otolaryngology · Paediatrics

Paradise Criteria for Tonsillectomy calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

episodes

Allowed range: 0–40 episodes

Quick picks

Count episodes of sore throat. Seven or more in the past year meets the one-year rule. Five or more in each of the past two years meets the two-year rule. Three or more in each of the past three years meets the three-year rule.

episodes

Allowed range: 0–40 episodes

Quick picks

Count episodes of sore throat. Seven or more in the past year meets the one-year rule. Five or more in each of the past two years meets the two-year rule. Three or more in each of the past three years meets the three-year rule.

episodes

Allowed range: 0–40 episodes

Quick picks

Count episodes of sore throat. Seven or more in the past year meets the one-year rule. Five or more in each of the past two years meets the two-year rule. Three or more in each of the past three years meets the three-year rule.

Temperature above 38.3°C

A counted episode is sore throat plus at least one of fever above 38.3°C, tender cervical nodes or nodes larger than 2 cm, tonsillar exudate, or a positive group A streptococcal culture.

Tender cervical nodes or nodes larger than 2 cm
Tonsillar exudate
Positive group A streptococcal culture
Antibiotics given for proved or suspected streptococcal episodes

Paradise required conventional-dose antibiotics for proved or suspected streptococcal episodes.

Documentation of the episodes

Either each episode and its qualifying features were written in the record at the time, or the record was incomplete and the clinician later observed two episodes with the same pattern.

Result

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Clinical inputs

  • Sore-throat episodes in the past yearAccepted range: 0 to 40
  • Sore-throat episodes in the year before thatAccepted range: 0 to 40
  • Sore-throat episodes in the year before those twoAccepted range: 0 to 40
  • Temperature above 38.3°C
  • Tender cervical nodes or nodes larger than 2 cm
  • Tonsillar exudate
  • Positive group A streptococcal culture
  • Antibiotics given for proved or suspected streptococcal episodes
  • Documentation of the episodes

Primary source

Mitchell RB et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg. DOI: 10.1177/0194599818801757. PMID: 30798778. Table 5 reprints the Paradise criteria from Paradise JL et al. N Engl J Med. 1984. PMID: 6700642. The frequency row already counts sore-throat episodes: seven or more in the preceding year, or five or more in each of the preceding 2 years, or three or more in each of the preceding 3 years. Footnote a defines each counted episode as sore throat plus at least one of temperature above 38.3°C, cervical lymphadenopathy that is tender or larger than 2 cm, tonsillar exudate, or a positive culture for group A beta-hemolytic streptococcus. There is no second sore-throat question. Antibiotics had been given in conventional dosage for proved or suspected streptococcal episodes. Each episode was written in the clinical record at the time, or, if documentation was incomplete, the clinician later observed two episodes with the same pattern. (2019)

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