Accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis

Mark H. Ebell, Brian McKay, Ariella Dale, Ryan Guilbault, Yokabed Ermias

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

PURPOSE To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS). METHODS We searched Medline to identify studies of outpatients with clinically suspected ARS and sufficient data reported to calculate the sensitivity and specificity. Of 1,649 studies initially identified, 17 met our inclusion criteria. Acute rhinosinusitis was diagnosed by any valid reference standard, whereas acute bacterial rhinosinusitis (ABRS) was diagnosed by purulence on antral puncture or positive bacterial culture. We used bivariate meta-analysis to calculate summary estimates of test accuracy. RESULTS Among patients with clinically suspected ARS, the prevalence of imaging confirmed ARS is 51% and ABRS is 31%. Clinical findings that best rule in ARS are purulent secretions in the middle meatus (positive likelihood ratio [LR+] 3.2) and the overall clinical impression (LR+ 3.0). The findings that best rule out ARS are the overall clinical impression (negative likelihood ratio [LR–] 0.37), normal transillumination (LR– 0.55), the absence of preceding respiratory tract infection (LR– 0.48), any nasal discharge (LR– 0.49), and purulent nasal discharge (LR– 0.54). Based on limited data, the overall clinical impression (LR+ 3.8, LR– 0.34), cacosmia (fetid odor on the breath) (LR+ 4.3, LR– 0.86) and pain in the teeth (LR+ 2.0, LR– 0.77) are the best predictors of ABRS. While several clinical decision rules have been proposed, none have been prospectively validated. CONCLUSIONS Among patients with clinically suspected ARS, only about one-third have ABRS. The overall clinical impression, cacosmia, and pain in the teeth are the best predictors of ABRS. Clinical decision rules, including those incorporating C-reactive protein, and use of urine dipsticks are promising, but require prospective validation.

Original languageEnglish (US)
Pages (from-to)164-172
Number of pages9
JournalAnnals of family medicine
Volume17
Issue number2
DOIs
StatePublished - Mar 1 2019

Fingerprint

Olfaction Disorders
Nose
Signs and Symptoms
Tooth
Transillumination
Pain
Punctures
Respiratory Tract Infections
C-Reactive Protein
Meta-Analysis
Outpatients
Urine
Sensitivity and Specificity
Antral
Odorants

Keywords

  • Acute rhinosinusitis
  • Acute sinusitis
  • Clinical diagnosis
  • Rhinosinusitis
  • Sinusitis

ASJC Scopus subject areas

  • Family Practice

Cite this

Accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis. / Ebell, Mark H.; McKay, Brian; Dale, Ariella; Guilbault, Ryan; Ermias, Yokabed.

In: Annals of family medicine, Vol. 17, No. 2, 01.03.2019, p. 164-172.

Research output: Contribution to journalArticle

Ebell, Mark H. ; McKay, Brian ; Dale, Ariella ; Guilbault, Ryan ; Ermias, Yokabed. / Accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis. In: Annals of family medicine. 2019 ; Vol. 17, No. 2. pp. 164-172.
@article{c2dc4d45f7d349d68bbd9c32b0e49b9d,
title = "Accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis",
abstract = "PURPOSE To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS). METHODS We searched Medline to identify studies of outpatients with clinically suspected ARS and sufficient data reported to calculate the sensitivity and specificity. Of 1,649 studies initially identified, 17 met our inclusion criteria. Acute rhinosinusitis was diagnosed by any valid reference standard, whereas acute bacterial rhinosinusitis (ABRS) was diagnosed by purulence on antral puncture or positive bacterial culture. We used bivariate meta-analysis to calculate summary estimates of test accuracy. RESULTS Among patients with clinically suspected ARS, the prevalence of imaging confirmed ARS is 51{\%} and ABRS is 31{\%}. Clinical findings that best rule in ARS are purulent secretions in the middle meatus (positive likelihood ratio [LR+] 3.2) and the overall clinical impression (LR+ 3.0). The findings that best rule out ARS are the overall clinical impression (negative likelihood ratio [LR–] 0.37), normal transillumination (LR– 0.55), the absence of preceding respiratory tract infection (LR– 0.48), any nasal discharge (LR– 0.49), and purulent nasal discharge (LR– 0.54). Based on limited data, the overall clinical impression (LR+ 3.8, LR– 0.34), cacosmia (fetid odor on the breath) (LR+ 4.3, LR– 0.86) and pain in the teeth (LR+ 2.0, LR– 0.77) are the best predictors of ABRS. While several clinical decision rules have been proposed, none have been prospectively validated. CONCLUSIONS Among patients with clinically suspected ARS, only about one-third have ABRS. The overall clinical impression, cacosmia, and pain in the teeth are the best predictors of ABRS. Clinical decision rules, including those incorporating C-reactive protein, and use of urine dipsticks are promising, but require prospective validation.",
keywords = "Acute rhinosinusitis, Acute sinusitis, Clinical diagnosis, Rhinosinusitis, Sinusitis",
author = "Ebell, {Mark H.} and Brian McKay and Ariella Dale and Ryan Guilbault and Yokabed Ermias",
year = "2019",
month = "3",
day = "1",
doi = "10.1370/afm.2354",
language = "English (US)",
volume = "17",
pages = "164--172",
journal = "Annals of Family Medicine",
issn = "1544-1709",
publisher = "Annals of Family Medicine, Inc",
number = "2",

}

TY - JOUR

T1 - Accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis

AU - Ebell, Mark H.

AU - McKay, Brian

AU - Dale, Ariella

AU - Guilbault, Ryan

AU - Ermias, Yokabed

PY - 2019/3/1

Y1 - 2019/3/1

N2 - PURPOSE To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS). METHODS We searched Medline to identify studies of outpatients with clinically suspected ARS and sufficient data reported to calculate the sensitivity and specificity. Of 1,649 studies initially identified, 17 met our inclusion criteria. Acute rhinosinusitis was diagnosed by any valid reference standard, whereas acute bacterial rhinosinusitis (ABRS) was diagnosed by purulence on antral puncture or positive bacterial culture. We used bivariate meta-analysis to calculate summary estimates of test accuracy. RESULTS Among patients with clinically suspected ARS, the prevalence of imaging confirmed ARS is 51% and ABRS is 31%. Clinical findings that best rule in ARS are purulent secretions in the middle meatus (positive likelihood ratio [LR+] 3.2) and the overall clinical impression (LR+ 3.0). The findings that best rule out ARS are the overall clinical impression (negative likelihood ratio [LR–] 0.37), normal transillumination (LR– 0.55), the absence of preceding respiratory tract infection (LR– 0.48), any nasal discharge (LR– 0.49), and purulent nasal discharge (LR– 0.54). Based on limited data, the overall clinical impression (LR+ 3.8, LR– 0.34), cacosmia (fetid odor on the breath) (LR+ 4.3, LR– 0.86) and pain in the teeth (LR+ 2.0, LR– 0.77) are the best predictors of ABRS. While several clinical decision rules have been proposed, none have been prospectively validated. CONCLUSIONS Among patients with clinically suspected ARS, only about one-third have ABRS. The overall clinical impression, cacosmia, and pain in the teeth are the best predictors of ABRS. Clinical decision rules, including those incorporating C-reactive protein, and use of urine dipsticks are promising, but require prospective validation.

AB - PURPOSE To evaluate the accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis (ARS). METHODS We searched Medline to identify studies of outpatients with clinically suspected ARS and sufficient data reported to calculate the sensitivity and specificity. Of 1,649 studies initially identified, 17 met our inclusion criteria. Acute rhinosinusitis was diagnosed by any valid reference standard, whereas acute bacterial rhinosinusitis (ABRS) was diagnosed by purulence on antral puncture or positive bacterial culture. We used bivariate meta-analysis to calculate summary estimates of test accuracy. RESULTS Among patients with clinically suspected ARS, the prevalence of imaging confirmed ARS is 51% and ABRS is 31%. Clinical findings that best rule in ARS are purulent secretions in the middle meatus (positive likelihood ratio [LR+] 3.2) and the overall clinical impression (LR+ 3.0). The findings that best rule out ARS are the overall clinical impression (negative likelihood ratio [LR–] 0.37), normal transillumination (LR– 0.55), the absence of preceding respiratory tract infection (LR– 0.48), any nasal discharge (LR– 0.49), and purulent nasal discharge (LR– 0.54). Based on limited data, the overall clinical impression (LR+ 3.8, LR– 0.34), cacosmia (fetid odor on the breath) (LR+ 4.3, LR– 0.86) and pain in the teeth (LR+ 2.0, LR– 0.77) are the best predictors of ABRS. While several clinical decision rules have been proposed, none have been prospectively validated. CONCLUSIONS Among patients with clinically suspected ARS, only about one-third have ABRS. The overall clinical impression, cacosmia, and pain in the teeth are the best predictors of ABRS. Clinical decision rules, including those incorporating C-reactive protein, and use of urine dipsticks are promising, but require prospective validation.

KW - Acute rhinosinusitis

KW - Acute sinusitis

KW - Clinical diagnosis

KW - Rhinosinusitis

KW - Sinusitis

UR - http://www.scopus.com/inward/record.url?scp=85062862972&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062862972&partnerID=8YFLogxK

U2 - 10.1370/afm.2354

DO - 10.1370/afm.2354

M3 - Article

VL - 17

SP - 164

EP - 172

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 2

ER -