RT Journal Article
SR Electronic
T1 Risk of Acute Rhinosinusitis Progression Based on Duration of Symptoms, Method of Care, and Setting of Care
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 6558
DO 10.1370/afm.22.s1.6558
VO 22
IS Supplement 1
A1 Fencil, Charles
A1 Turnquist, Alyssa
A1 Krist, Alex
A1 Messmer, Mindi
A1 Shara, Nawar
A1 Fernandez, Stephen
A1 Rabago, David
A1 Henningfield, Mary
A1 Tarn, Derjung
A1 Merenstein, Daniel
A1 Villalobos, Gabriela
A1 Smith, Keisha Herbin
A1 Blaker, Joshua
A1 Sparenborg, Jessy
A1 Tong, Sebastian
A1 Franko, Nicholas
A1 Casey, Cameron
A1 Schramm, Danielle
A1 Keiser, Brennan
A1 Tan, Tina
A1 Whitfield, Michael
A1 Stienecker, Sara
A1 Zgierska, Aleksandra
A1 Mete, Mihriye
A1 Sanghavi, Kavya
A1 Imam, Syed Junaid
YR 2024
UL http://www.annfammed.org/content/22/Supplement_1/6558.abstract
AB Context: One of the most common primary care illnesses is acute rhinosinusitis (ARS). Guidelines currently suggest treating ARS with antibiotics when persistent symptoms or double sickening occur.Objective: To identify the factors associated with progression from upper respiratory infection to ARS.Study Design: As part of a large multi-center pragmatic randomized comparative effectiveness trial funded by PCORI, we recruited 141 adults with upper respiratory tract infections as part of a pilot feasibility demonstration. Participants were initially treated symptomatically (e.g. nasal saline, acetaminophen), but if symptoms persisted or worsened on day 9, they were considered to have ARS and randomized to one of four interventions (antibiotics, nasal steroid, both, or only nasal saline).Setting & Population: Six practice-based research networks recruited patients aged 18-65 years with upper respiratory symptoms. Patients were recruited from primary care practices, emergency rooms and urgent care centers, and the community (e.g., recruitment flyers). Patients with 1 to 9 days of symptoms were included, and patients could have an in person or telemedicine appointment with a clinician.Outcome: The primary outcome was progression to ARS and study randomization, and secondary outcome was mSNOT score at enrollment and day 9.Results: The median age was 35 (26-48) years. The demographics between those who progressed to ARS and those who got better were generally similar, including age, gender, race, education, employment, and type of health insurance. Patients with a telemedicine versus in person visit had a lower, but not statistically significant, rate of progression to ARS (50% vs 64%, p=0.375). Patients recruited in primary versus urgent care clinics had similar rates of progression to ARS, but the community rate was lower (69% vs 65% vs 45%, p=0.085). A greater proportion of patients recruited later in their illness (day 7-9) were more likely to progress to ARS than those recruited day 4-6 or day 1-3 of their upper respiratory illness, but differences were not statistically significant (65% vs 50% vs 41%, p=0.187). Interestingly, primary care practices saw fewer patients with acute upper respiratory infections than anticipated.Conclusion: Patients with upper respiratory infections recruited in different settings with different approaches were more similar than different, supporting a broad multimodal recruitment approach.