Individual symptom visual analogue scale severity scores for determining EPOS guideline-based chronic rhinosinusitis disease control

Abstract

Background: The goal of this study was to determine how to translate visual analogue scale (VAS) symptom scores to the binary, descriptive symptom scales used in the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria for chronic rhinosinusitis (CRS) disease control. Methods: 309 CRS patients were recruited. All patients rated their burden of 5 symptoms (nasal blockage, rhinorrhea/postnasal drip, facial pain/pressure, smell loss, sleep disturbance or fatigue) using the binary EPOS descriptive symptom scales and a VAS (on a scale of 0 to 10). In addition, participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and rated their overall CRS disease control as “controlled”, “partly controlled” or “uncontrolled”. Results: Symptom burdens measured by VAS, binary descriptive EPOS scale and SNOT-22 were associated with worsening CRS disease control reported by participants. Each symptom had a distinct VAS score cut-off that strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale. However, the predictive ability of VAS for rhinorrhea/ postnasal drip was disparately worse than the other 4 symptoms. When considering all symptom data simultaneously, a VAS score >3.5 strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale for all 5 symptoms. Conclusions: A VAS symptom score of >3.5 translates to the uncontrolled option in the binary, descriptive symptom scale of the EPOS control criteria. The rhinorrhea/postnasal drip descriptive symptom scale translates disparately worse to VAS scores and may be considered for revision in future criteria.

Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control

“…14 A total of two hundred patients' deidentified data were chosen from a previously described dataset used to study CRS disease control. 12 Other than to represent data from patients who reported their CRS disease control as "controlled" versus "partly controlled" versus "uncontrolled" as evenly as possible, patient data was randomly chosen. A total of 15 rhinologists were recruited to be able to detect a difference of large effect size in the agreement between rhinologistassessed CRS control and patient-reported CRS control from the first data set (when patient-reported CRS control was provided) and the second data set (when patientreported CRS control was not provided) with a power of 0.8 and with a significance of 0.05.…”

“…These deidentified patient data were taken from a previous study in which the CRS symptom severities were collected from patients using the same dichotomous scales for the EPOS CRS control criteria, and in which patients also rated their own CRS disease control on a scale of "controlled," "partly controlled," or "uncontrolled." 12 Based on the EPOS disease control criteria and patientreported CRS control, participating rhinologists were asked to classify each patient's CRS disease control on a scale of "controlled," "partly controlled," and "uncontrolled," which is consistent with the EPOS disease control classifications and guideline classifications of asthma control. 5,13 Participating rhinologists were specifically instructed that CRS control was defined as the extent to which CRS manifestations were within acceptable limits and that CRS control serves as the goal of treatment, with the corollary that a rating of partly controlled or uncontrolled CRS implied that the rhinologist would consider treatment change or escalation in proportion to the lack of control.…”

“…Data reflecting CRS disease manifestations/burden consisted of the seven criteria used in the EPOS CRS disease control guidelines, with patients’ CRS symptom severities over the prior month given to participants using the descriptive dichotomies for nasal blockage (“not present or not bothersome” vs. “present on most days of the week”), rhinorrhea/postnasal drip (“little and mucous” vs. “mucopurulent on most days of the week”), facial pain/pressure (“not present or not bothersome” vs. “present on most days of the week”), sense of smell (“normal or only slightly impaired” vs. “impaired”), and sleep disturbance or fatigue (“not present” vs. “present”), as well as use of rescue medications (antibiotics or oral corticosteroids for CRS) in the last 6 months and the presence of diseased mucosa on nasal endoscopy 5,6 . Patient‐reported CRS control, when provided, was classified as “controlled,” “partly controlled,” or “uncontrolled.” These deidentified patient data were taken from a previous study in which the CRS symptom severities were collected from patients using the same dichotomous scales for the EPOS CRS control criteria, and in which patients also rated their own CRS disease control on a scale of “controlled,” “partly controlled,” or “uncontrolled.” 12 …”

“…All analyses were performed using the statistical software package R (http://www.r-project.org). 14 A total of two hundred patients’ deidentified data were chosen from a previously described dataset used to study CRS disease control 12 . Other than to represent data from patients who reported their CRS disease control as “controlled” versus “partly controlled” versus “uncontrolled” as evenly as possible, patient data was randomly chosen.…”

Defining ‘control’ of chronic rhinosinusitis

“…The 2020 EPOS CRS control guidelines also proposed the possibility of dichotomizing symptom criteria based on a corresponding visual analogue scale (VAS) symptom severity score of 5 or less vs. more than 5 (on a scale of 0-10) based on inference from previous work that did not directly address the conversion of VAS symptom severity scores to descriptive symptom criteria [1,9]. More recent work and direct study of the issue has demonstrated that the dichotomization of VAS symptom severity scores as less than 3.5 vs. at least 3.5 (on a scale of 0-10) better corresponds to the descriptive symptom criteria of the EPOS CRS control guidelines [10].…”