A randomized trial examining the effect of pretreatment point‐of‐care computed tomography imaging on the management of patients with chronic rhinosinusitis symptoms

Abstract

In patients with symptoms of CRS but negative endoscopy, POC at initial presentation results in substantially less unnecessary antibiotic prescriptions and significantly greater compliance with otolaryngology care but does result in a higher utilization of radiographic imaging.

Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis

“…These findings suggest that subjects with comorbidities characterized by chronic head and neck pain or depression/anxiety may have lower pretest probabilities of CRS, and thus benefit from earlier CT and neurologic evaluation, rather than trials of extended antimicrobial therapy. Prior work by Tan et al supports the notion that upfront CT may be advantageous over empiric antibiotic therapy in the primary care setting …”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…675,684 Based on CMS costs and published drug cost information in the United States, an extended course of antibiotic therapy is similar to that of obtaining a CT, and adopting an upfront CT results in substantially reduced antibiotic utilization in symptomatic patients with alternate diagnoses such as rhinitis or atypical facial pain. 685,686 These benefits are traditionally weighed against additional imaging-related concerns such as radiation exposure and access. The availability of alternative CT imaging modalities such as cone beam technologies mitigates some of these concerns by facilitating CT availability at the point of care and lowering radiation exposure while maintaining the quality of diagnostic information necessary for CRS.…”

Patient knowledge and perception of computed tomography scan in the management of chronic rhinosinusitis symptoms

“…Fewer guidelines exist on the timing and utilization of CT for initial evaluation of patients with CRS symptoms, with limited information on the threshold of previous empiric medical therapy needed prior to imaging. Due to the poor positive predictive value of the cardinal symptoms of CRS, up‐front CT imaging for establishing initial diagnosis and dictating care of the patient with sinusitis symptoms results in significantly lower antibiotic use, less costly care, and improves patient compliance with prescribed medical care …”

“…Because studies suggest that the sensitivity of nasal endoscopy is as low as 36% when compared to computed tomography (CT) imaging, CT is generally regarded as the gold standard imaging for confirmation of CRS . In recent years, low radiation point‐of‐care (POC) CT has become more available and has the potential to avert unnecessary treatment and achieve cost savings in the long run . Although there are protocol variations among institutions, a paranasal sinus CT typically involves a radiation dose of 0.6 to 1.1 mSv from a conventional multidetector CT (MDCT) and 0.04 to 0.17 mSv in a cone beam CT (CBCT) .…”

“…1 In recent years, low radiation point-of-care (POC) CT has become more available and has the potential to avert unnecessary treatment and achieve cost savings in the long run. [2][3][4][5] Although there are protocol variations among institutions, a paranasal sinus CT typically involves a radiation dose of 0.6 to 1.1 mSv from a conventional multidetector CT (MDCT) and 0.04 to 0.17 mSv in a cone beam CT (CBCT). 6,7 Depending on a person's geographic location, these exposures are within, or below, estimated annual radiation from natural sources and cosmic radiation, which vary from 1 to 10 mSv.…”