Timo J Autio1, Timo Koskenkorva1,2, Mervi Närkiö3, Tuomo K Leino2, Petri Koivunen1, Olli-Pekka Alho1. 1. Department of Otorhinolaryngology and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu. 2. Air Force Command Finland, Finnish Defence Forces, Finland. 3. Centre for Military Medicine, Finnish Defence Forces, Finland.
Abstract
OBJECTIVES/HYPOTHESIS: To evaluate the diagnostic accuracy of symptoms, the symptom progression pattern, and clinical signs in identifying bacterial acute rhinosinusitis (ARS). STUDY DESIGN: We conducted an inception cohort study among 50 military recruits with ARS. METHODS: We collected symptoms daily from the onset of symptoms to approximately 10 days. At 9 to 10 days, standardized data on symptoms and physical findings were gathered. A positive culture of maxillary sinus aspirate was considered to be the reference standard for bacterial ARS. RESULTS: At 9 to 10 days, the presence or deterioration after 5 days of any of the symptoms could not be used to diagnose bacterial ARS. Toothache had an adequate positive likelihood ratio (positive likelihood ratio [LR+] 4.4) but was too rare to be used for screening. In contrast, several physical findings at 9 to 10 days were of more diagnostic use and frequent enough for screening. Moderate or profuse (vs. none/minimal) amount of secretion in nasal passage seen in anterior rhinoscopy satisfactorily either ruled in, if present (LR+ 3.2), or ruled out, if absent (negative likelihood ratio 0.2), bacterial ARS. If any secretion was seen in the posterior pharynx or middle meatus, the probability of bacterial ARS increased markedly (LR+ 5.3 and LR+ 11.0, respectively). CONCLUSION: We found symptoms or their change to be of little use in identifying bacterial ARS. In contrast, we observed several clinical findings after 9 to 10 days of symptoms to predict bacterial ARS quite accurately.
OBJECTIVES/HYPOTHESIS: To evaluate the diagnostic accuracy of symptoms, the symptom progression pattern, and clinical signs in identifying bacterial acute rhinosinusitis (ARS). STUDY DESIGN: We conducted an inception cohort study among 50 military recruits with ARS. METHODS: We collected symptoms daily from the onset of symptoms to approximately 10 days. At 9 to 10 days, standardized data on symptoms and physical findings were gathered. A positive culture of maxillary sinus aspirate was considered to be the reference standard for bacterial ARS. RESULTS: At 9 to 10 days, the presence or deterioration after 5 days of any of the symptoms could not be used to diagnose bacterial ARS. Toothache had an adequate positive likelihood ratio (positive likelihood ratio [LR+] 4.4) but was too rare to be used for screening. In contrast, several physical findings at 9 to 10 days were of more diagnostic use and frequent enough for screening. Moderate or profuse (vs. none/minimal) amount of secretion in nasal passage seen in anterior rhinoscopy satisfactorily either ruled in, if present (LR+ 3.2), or ruled out, if absent (negative likelihood ratio 0.2), bacterial ARS. If any secretion was seen in the posterior pharynx or middle meatus, the probability of bacterial ARS increased markedly (LR+ 5.3 and LR+ 11.0, respectively). CONCLUSION: We found symptoms or their change to be of little use in identifying bacterial ARS. In contrast, we observed several clinical findings after 9 to 10 days of symptoms to predict bacterial ARS quite accurately.
Authors: Marieke B Lemiengre; Mieke L van Driel; Dan Merenstein; Helena Liira; Marjukka Mäkelä; An Im De Sutter Journal: Cochrane Database Syst Rev Date: 2018-09-10
Authors: Roderick Venekamp; Jens Georg Hansen; Johannes B Reitsma; Mark H Ebell; Morten Lindbaek Journal: BMJ Open Date: 2020-11-03 Impact factor: 2.692