Combinations of Findings and Clinical Decision Rules for the Diagnosis of Acute Sinusitis
| Study | Reference Standard | Findings | Interpretation | ||
|---|---|---|---|---|---|
| Result | Likelihood Ratio (95% CI) | Probability of Sinusitis, %a | |||
| Diagnosis of ARS | |||||
| Huang et al,24 2008b | Radiograph (n = 205) or CT (n = 12) | Leukocyte esterase: <1+ = 0, 1+ = 2, ≥2+ = 3 | 4-11 | 127.0 (8.1-2016.0) | 99 |
| 2-3 | 0.23 (0.10-0.52) | 13 | |||
| pH: <7.5 = 0, 7.5 = 1, 8.0 = 2, 8.5 = 3 Nitrite: none = 0, light pink = 1, dark pink = 2 Protein: <2+ = 0, 2+ = 1, 3+ = 2, 4+ = 3 | 0-1 | 0.00 (0.00-0.06) | 0 | ||
| Lindbaek et al,12 1996 | CT | Double sickening | 4 | 25.0 (3.5-177.0) | 94 |
| Purulent secretion in nasal cavity | 3 | 1.8 (1.1-3.2) | 55 | ||
| Purulent rhinorrhea (symptom) | 2 | 0.81 (0.51-1.30) | 35 | ||
| ESR >10 | 0-1 | 0.16 (0.09-0.30) | 10 | ||
| Williams et al,26 1992 | Radiograph | Maxillary toothache | 4-5 | 6.4 (2.2-19.0) | 81 |
| Abnormal transillumination | 3 | 2.6 (1.5-4.4) | 63 | ||
| Poor response to decongestants or antihistamines | 2 | 1.10 (0.73-1.70) | 42 | ||
| 1 | 0.43 (0.27-0.80) | 22 | |||
| Colored nasal discharge Mucopurulence on examination | 0 | 0.16 (0.04-0.41 | 10 | ||
| Van Diujn et al,27 1992 | Ultrasound (A mode) | Beginning with common cold | 5 | … | 89c |
| Purulent rhinorrhea | 1-4 | … | 18-82 | ||
| Pain at bending Unilateral maxillary pain Pain in teeth | 0 | … | 11 | ||
| Diagnosis of ABRS | |||||
| Berg et al,25 1988 | Purulent antral puncture fluid | Purulent rhinorrhea with unilateral predominance | 3-4 | 7.0 (3.9-12.7) | 82 |
| 2 | 1.30 (0.72-1.9) | 46 | |||
| Local pain with unilateral predominance Bilateral purulent rhinorrhea Pus in nasal cavity | 0-1 | 0.06 (0.02-0.17) | 4 | ||
| Ebell et al,36 2017 | Positive bacterial culture from antral fluid | Tender maxillary sinus (unilateral): 2 points | 7-8 | 5.0 (1.8-14) | 77 |
| 4-6 | 1.8 (1.3-2.5) | 55 | |||
| Maxillary toothache: 2 points C-reactive protein >15 mg/L: 2 points Preceding upper respiratory tract illness: 1 point Purulent nasal discharge: 1 point Previous sinusitis episodes: −1 point | −1-3 | 0.35 (0.21-0.56) | 19 | ||
ABRS = acute bacterial rhinosinusitis; ARS = acute rhinosinusitis; CT = computed tomography; ESR = erythrocyte sedimentation rate; LR = likelihood ratio.
↵a Calculated using the score-specific LR and a pretest probability of 40%, or taken directly from logistic model for each study.
↵b Results obtained from application of a urinalysis dipstick to nasal secretions.
↵c Probability of sinusitis calculated directly from logistic regression, so LR and its CI not estimable. Each variable is assigned a value of 1 for the presence of each finding and 0 for the absence. The score = −2.124 + 1.035*(beginning with common cold) + 0.996*(purulent rhinorrhea) + 0.95*(pain at bending) + 0.64*(unilateral maxillary pain) + 0.606*(pain in the teeth). A person with all findings present would have a maximum score of 2.103. The probability of sinusitis is calculated from exp(score)/[1 + exp(score)], so exp(2.103)/[1 + exp(2.103)]=89%. A person with none of the findings present would have a score of −2.124, or a probability of 11%.