Diagnosis of acute rhinosinusitis in primary care

A systematic review of test accuracy

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

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Acute rhinosinusitis (ARS) is a common primary care infection, but there have been no recent, comprehensive diagnostic meta- Analyses. Aim To determine the accuracy of laboratory and imaging studies for the diagnosis of ARS. Design and setting Systematic review of diagnostic tests in outpatient, primary care, and specialty settings. Method The authors included studies of patients presenting with or referred for suspected ARS, and used bivariate meta- Analysis to calculate summary estimates of test accuracy and the area under the receiver operating characteristic (ROC) curve. The authors also plotted summary ROC curves to explore heterogeneity, cutoffs, and the impact of different reference standards. Results Using antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR- 0.69), and radiography (LR+ 2.01, LR- 0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+ 12.4, LR- 0.35) and radiography (LR+ 9.4, LR- 0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR- 0.17) but has not been validated. Conclusion In general, tests were of limited value in the diagnosis of ARS. Normal radiography helps rule out sinusitis when negative, whereas CRP and ESR help rule in sinusitis when positive, although, given their limited accuracy as individual tests, they cannot be routinely recommended. Prospective studies integrating signs and symptoms with point-of-care CRP, dipstick, and/ or handheld B-mode ultrasound are needed.

Original languageEnglish (US)
Pages (from-to)e612-e632
JournalBritish Journal of General Practice
Volume66
Issue number650
DOIs
StatePublished - Sep 1 2016

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Blood Sedimentation
Radiography
C-Reactive Protein
Primary Health Care
Sinusitis
ROC Curve
Meta-Analysis
Point-of-Care Systems
Ambulatory Care
Nose
Punctures
Routine Diagnostic Tests
Signs and Symptoms
Prospective Studies
Infection

Keywords

  • Acute rhinosinusitis
  • Acute sinusitis
  • Clinical decision-making
  • Clinical diagnosis
  • Primary care
  • Rhinosinusitis
  • Sinusitis

ASJC Scopus subject areas

  • Family Practice

Cite this

Diagnosis of acute rhinosinusitis in primary care : A systematic review of test accuracy. / Ebell, Mark H.; McKay, Brian; Guilbault, Ryan; Ermias, Yokabed.

In: British Journal of General Practice, Vol. 66, No. 650, 01.09.2016, p. e612-e632.

Research output: Contribution to journalArticle

Ebell, Mark H. ; McKay, Brian ; Guilbault, Ryan ; Ermias, Yokabed. / Diagnosis of acute rhinosinusitis in primary care : A systematic review of test accuracy. In: British Journal of General Practice. 2016 ; Vol. 66, No. 650. pp. e612-e632.
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abstract = "Background Acute rhinosinusitis (ARS) is a common primary care infection, but there have been no recent, comprehensive diagnostic meta- Analyses. Aim To determine the accuracy of laboratory and imaging studies for the diagnosis of ARS. Design and setting Systematic review of diagnostic tests in outpatient, primary care, and specialty settings. Method The authors included studies of patients presenting with or referred for suspected ARS, and used bivariate meta- Analysis to calculate summary estimates of test accuracy and the area under the receiver operating characteristic (ROC) curve. The authors also plotted summary ROC curves to explore heterogeneity, cutoffs, and the impact of different reference standards. Results Using antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR- 0.69), and radiography (LR+ 2.01, LR- 0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+ 12.4, LR- 0.35) and radiography (LR+ 9.4, LR- 0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR- 0.17) but has not been validated. Conclusion In general, tests were of limited value in the diagnosis of ARS. Normal radiography helps rule out sinusitis when negative, whereas CRP and ESR help rule in sinusitis when positive, although, given their limited accuracy as individual tests, they cannot be routinely recommended. Prospective studies integrating signs and symptoms with point-of-care CRP, dipstick, and/ or handheld B-mode ultrasound are needed.",
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N2 - Background Acute rhinosinusitis (ARS) is a common primary care infection, but there have been no recent, comprehensive diagnostic meta- Analyses. Aim To determine the accuracy of laboratory and imaging studies for the diagnosis of ARS. Design and setting Systematic review of diagnostic tests in outpatient, primary care, and specialty settings. Method The authors included studies of patients presenting with or referred for suspected ARS, and used bivariate meta- Analysis to calculate summary estimates of test accuracy and the area under the receiver operating characteristic (ROC) curve. The authors also plotted summary ROC curves to explore heterogeneity, cutoffs, and the impact of different reference standards. Results Using antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR- 0.69), and radiography (LR+ 2.01, LR- 0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+ 12.4, LR- 0.35) and radiography (LR+ 9.4, LR- 0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR- 0.17) but has not been validated. Conclusion In general, tests were of limited value in the diagnosis of ARS. Normal radiography helps rule out sinusitis when negative, whereas CRP and ESR help rule in sinusitis when positive, although, given their limited accuracy as individual tests, they cannot be routinely recommended. Prospective studies integrating signs and symptoms with point-of-care CRP, dipstick, and/ or handheld B-mode ultrasound are needed.

AB - Background Acute rhinosinusitis (ARS) is a common primary care infection, but there have been no recent, comprehensive diagnostic meta- Analyses. Aim To determine the accuracy of laboratory and imaging studies for the diagnosis of ARS. Design and setting Systematic review of diagnostic tests in outpatient, primary care, and specialty settings. Method The authors included studies of patients presenting with or referred for suspected ARS, and used bivariate meta- Analysis to calculate summary estimates of test accuracy and the area under the receiver operating characteristic (ROC) curve. The authors also plotted summary ROC curves to explore heterogeneity, cutoffs, and the impact of different reference standards. Results Using antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR- 0.69), and radiography (LR+ 2.01, LR- 0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+ 12.4, LR- 0.35) and radiography (LR+ 9.4, LR- 0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR- 0.17) but has not been validated. Conclusion In general, tests were of limited value in the diagnosis of ARS. Normal radiography helps rule out sinusitis when negative, whereas CRP and ESR help rule in sinusitis when positive, although, given their limited accuracy as individual tests, they cannot be routinely recommended. Prospective studies integrating signs and symptoms with point-of-care CRP, dipstick, and/ or handheld B-mode ultrasound are needed.

KW - Acute rhinosinusitis

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KW - Clinical decision-making

KW - Clinical diagnosis

KW - Primary care

KW - Rhinosinusitis

KW - Sinusitis

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