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The Article in Brief
Proposed Clinical Decision Rules to Diagnose Acute Rhinosinusitis Among Adults in Primary Care
Mark H. Ebell , and colleagues
Background Practice guidelines only recommend the use of antibiotics in patients with prolonged, severe, or worsening symptoms of acute rhinosinusitis (ARS), when the likelihood of a bacterial cause is thought to be higher. However, it is common practice for patients diagnosed with acute rhinosinusitis to be prescribed an antibiotic regardless of the duration of symptoms or their severity. One strategy to reduce inappropriate prescribing is to give physicians tools that can help them more confidently diagnose or rule out acute bacterial rhinosinusitis (ABRS). This study set out to develop a clinical decision rule to diagnose acute rhinosinusitis and acute bacterial rhinosinusitis.
What This Study Found Researchers developed a series of clinical decision rules integrating signs, symptoms, and C-reactive protein that diagnose acute rhinosinusitis and acute bacterial rhinosinusitis with good accuracy. They developed a point score and algorithm for each of 3 reference standards: abnormal CT scan, abnormal antral puncture, or positive bacterial culture. They found that the most appropriate reference standard is positive bacterial culture of antral puncture fluid. The point score using this reference standard successfully identified groups with a low (16 percent), moderate (49 percent) and high (73 percent) likelihood of acute bacterial rhinosinusitis.
Implications
- By identifying patients at low risk for a bacterial infection, this clinical decision rule can lead to more conservative use of antibiotics and help reduce inappropriate antibiotic prescribing.
- According to the authors, prospective validation of the findings and an assessment of their effect on clinical and process outcomes are important next steps.