Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography.

Duijn, N. P. van; Brouwer, Henk J.; Lamberts, H

doi:10.1136/bmj.305.6855.684

Cited by 80 publications

(41 citation statements)

References 17 publications

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“…Sixty-three percent of the patients had radiological signs of sinusitis. This is consistent with the findings of the Dutch study (21) and an investigation of the general practioners' own assessment of the difficulty and clinical uncertainty of this diagnosis (1 1). Of the patients with a clinically diagnosed acute sinusitis 24% had negative CT images, and 13% had moderate mucosal changes.…”

Section: Interobserver Variationsupporting

confidence: 90%

“…Clinical diagnosis of acute sinusitis is not accurate (7,21). In the Dutch study, clinical diagnosis was confirmed by ultrasonography in less than half of the diagnosed episodes (21).…”

mentioning

confidence: 94%

“…One Swedish study showed that sinusitis constituted 2% of the reasons for encounter in general practice (7). In studies from British and Dutch general practice, where the diagnosis was based on clinical examination only, an incidence of 21-28 episodes of acute sinusitis per 1000 patients per year was found (18,21). Acute sinusitis is usually diagnosed on the basis of symptoms and signs; few patients are referred to radiography-or ENTspecialist examination (7,11).…”

mentioning

confidence: 99%

See 2 more Smart Citations

CT Findings in General Practice Patients with Suspected Acute Sinusitis

Lindbæk¹,

Johnsen²,

Kaastad³

et al. 1996

Acta Radiol

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Section: Interobserver Variationsupporting

confidence: 90%

“…Clinical diagnosis of acute sinusitis is not accurate (7,21). In the Dutch study, clinical diagnosis was confirmed by ultrasonography in less than half of the diagnosed episodes (21).…”

mentioning

confidence: 94%

mentioning

confidence: 99%

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CT Findings in General Practice Patients with Suspected Acute Sinusitis

Lindbæk¹,

Johnsen²,

Kaastad³

et al. 1996

Acta Radiol

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“…With respect to the disagreements in the timing of decision, the uncertainty of the diagnosis might be an important reason (17), and the uncertainty of the effectiveness of antibiotics might also play a role. Waiting while providing patients with information and prescribing analgesics and/or prescribing local therapy (nasal spray) were important management options.…”

Section: Discussionmentioning

confidence: 99%

Acute maxillary sinusitis in general practice: A decision problem

Bock

Kievit²,

1994

Scandinavian Journal of Primary Health Care

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“…6,7 Clinical decision rules have been proposed but have not been prospectively validated. [7][8][9][10][11] Also, many previous studies of individual tests or clinical decision rules have used radiography or computed tomographic (CT) scans as the ref-erence standard, tests that themselves have limited accuracy. 12 Although a CT scan is highly sensitive for the detection of fluid in the sinuses, this fluid may also be caused by a viral infection, so the test lacks specificity and is, therefore, a suboptimal reference standard.…”

Section: Introductionmentioning

confidence: 99%

Proposed Clinical Decision Rules to Diagnose Acute Rhinosinusitis Among Adults in Primary Care

Ebell

Hansen

2017

Ann Fam Med

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PURPOSE To reduce inappropriate antibiotic prescribing, we sought to develop a clinical decision rule for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis.METHODS Multivariate analysis and classification and regression tree (CART) analysis were used to develop clinical decision rules for the diagnosis of acute rhinosinusitis, defined using 3 different reference standards (purulent antral puncture fluid or abnormal finding on a computed tomographic (CT) scan; for acute bacterial rhinosinusitis, we used a positive bacterial culture of antral fluid). Signs, symptoms, C-reactive protein (CRP), and reference standard tests were prospectively recorded in 175 Danish patients aged 18 to 65 years seeking care for suspected acute rhinosinusitis. For each reference standard, we developed 2 clinical decision rules: a point score based on a logistic regression model and an algorithm based on a CART model. We identified low-, moderate-, and high-risk groups for acute rhinosinusitis or acute bacterial rhinosinusitis for each clinical decision rule. RESULTSThe point scores each had between 5 and 6 predictors, and an area under the receiver operating characteristic curve (AUROCC) between 0.721 and 0.767. For positive bacterial culture as the reference standard, low-, moderate-, and high-risk groups had a 16%, 49%, and 73% likelihood of acute bacterial rhinosinusitis, respectively. CART models had an AUROCC ranging from 0.783 to 0.827. For positive bacterial culture as the reference standard, low-, moderate-, and high-risk groups had a likelihood of acute bacterial rhinosinusitis of 6%, 31%, and 59% respectively. CONCLUSIONSWe have developed a series of clinical decision rules integrating signs, symptoms, and CRP to diagnose acute rhinosinusitis and acute bacterial rhinosinusitis with good accuracy. They now require prospective validation and an assessment of their effect on clinical and process outcomes. Ann Fam Med 2017;15:347-354. https://doi.org/10.1370/afm.2060. INTRODUCTIONP ractice guidelines recommend the use of antibiotics only for patients with prolonged, severe, or worsening symptoms of acute rhinosinusitis, when the likelihood of a bacterial cause is thought to be higher.1,2 It is common practice, however, for patients with a diagnosis of acute rhinosinusitis to be prescribed an antibiotic regardless of the duration of symptoms or their severity.3 One strategy to reduce inappropriate prescribing is to give physicians tools that can help them more confidently diagnose or rule out acute bacterial rhinosinusitis.Previous studies have shown that individual signs and symptoms are of limited value for the diagnosis of acute bacterial rhinosinusitis.4,5 Point-ofcare tests, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are promising, but by themselves they are not adequate to diagnose or rule out acute bacterial rhinosinusitis. 6,7 Clinical decision rules have been proposed but have not been prospectively validated. 12 Although a CT scan is highly sensitive for the d...

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Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography.

Abstract: Objective-To establish the incidence ofmaxillary sinusitis in general practice and the predictive value of symptoms and signs.Design

Cited by 80 publications

References 17 publications

CT Findings in General Practice Patients with Suspected Acute Sinusitis

CT Findings in General Practice Patients with Suspected Acute Sinusitis

Acute maxillary sinusitis in general practice: A decision problem

Proposed Clinical Decision Rules to Diagnose Acute Rhinosinusitis Among Adults in Primary Care

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