Characteristics of Included Studies (N = 17)
| Study | Population | Age Data | Reference Standard | Country | Risk of Bias |
|---|---|---|---|---|---|
| Referral setting (ENT, respiratory, or allergy clinic) | |||||
| McNeill,13 1963 | Adults and children (n = 150, 242 sinuses) referred to ENT clinic for clinically suspected ARS | Range ≥10 y (10-19 y, n = 22; ≥20 y, n = 128) | Radiography showing mucosal thickening or any opacity | Northern Ireland | High |
| Axelsson et al,21 1976 | Consecutive adults (n = 164) at ENT clinic with clinically suspected acute maxillary sinusitis | Mean 35 y | Radiography (at least 4 views) showing any mucosal thickening, air-fluid levels, or opacification | Sweden | Moderate |
| Berg et al,15 1981 | Adults (n = 50) at ENT clinic with clinically suspected ARS of ≥3 weeks duration | Mean 46 y | Antral puncture revealing purulent discharge | Sweden | High |
| Berg et al,22 1985 | Adults (n = 90) at ENT clinic with clinically suspected ARS of ≥3 weeks duration | Not reported | Antral puncture revealing purulent discharge | Sweden | Moderate |
| van Buchem et al,5 1995 | Adults (n = 113) referred to ENT clinic with clinically suspected acute maxillary sinusitis | 42% 18-29 y; 34% 30-44 y; 16% 45-59 y; and 9% ≥60 y | (1) Antral puncture showing fluid or floccules (by patient) and (2) bacterial culture of fluid (by sinus) | Netherlands | Low |
| Visca et al,23 1995 | Children (n = 30) at pediatric respiratory clinic with clinically suspected ARS | Range 5-15 y | CT scan abnormal in coronal projection | Italy | High |
| Huang et al,24 2008 | Consecutive adults and children (n = 217) at allergy clinic with clinically suspected ARS of <3 weeks duration | Range 4-61 y (4-9 y, n = 89; 10-19 y, n = 101; ≥20 y, n = 27) | Sinus radiograph (n = 151) or CT scan (n = 12) with >4 mm mucosal thickening, air-fluid levels, and/or increased opacity or retention cyst | USA | High |
| Primary care, urgent care, or emergency department setting | |||||
| Berg et al,25 1988 | Adults (n = 155) presenting to ED with clinically suspected maxillary sinusitis of <3 months duration | Mean 38 y | Antral puncture with return of purulent or cloudy fluid | Sweden | Moderate |
| Williams et al,26 1992 | Consecutive men (n = 247) presenting to VA general medicine clinic with <3 months of self-described sinusitis or at least 1 sinus symptom–median symptom duration of 11 days | Median 50 y, IQ range 40-63 y | Radiographs (4 views): mucosal thickening ≥6 mm, complete opacity, or air-fluid level | USA | Moderate |
| van Duijn et al,27 1992 | Adults (n = 400, 441 episodes) presenting to primary care clinic with clinically suspected ARS | Range ≥15 y | Ultrasonography abnormal | Netherlands | Moderate |
| Hansen et al,4 1995 | Consecutive adults (n = 174) at primary care clinic suspected of having acute maxillary sinusitis by their general practitioner | Median 35 y, range 18-65 y | CT scan abnormal and culture of purulent fluid positive for pathogenic bacteria | Denmark | Low |
| Lindbaek et al,12 1996 | Adults (n = 201) clinically diagnosed by primary care doctor with ARS requiring antibiotics | Mean 37.8, range 15-83 y | CT scan showing air-fluid level or complete opacification | Norway | High |
| Laine et al,28 1998 | Consecutive adults (n = 39) presenting to primary care clinic with clinically suspected acute maxillary sinusitis of <30 days duration | Median 37 y, range 16-68 y | Nasal aspirate with purulent or mucopurulent material | Finland | Low |
| Varonen et al,29 2003 | Consecutive adults (n = 148) presenting to a primary care clinic with clinically suspected ARS of <30 days duration, 72% >5 days | Mean 39.7 y, range 18-75 y | Sinus radiographs (AP and Waters’ views) showing total opacification, air-fluid level, or mucosal thickening ≥6 mm | Finland | High |
| Thomas et al,30 2006 | Adults (n = 60) presenting to a VA urgent care center with clinically suspected ARS of <4 weeks duration | Mean 51 y, range 25-83 y | CT scan showing air-fluid level or complete opacification (mucosal thickening alone was not considered diagnostic) | USA | Moderate |
| Shaikh et al,31 2013 | Children (n = 258) at a general pediatric clinic with clinically suspected ARS of <30 days durations (mean symptom duration 14 days) | Mean 6.4 y, range 2.0-12.9 y | Radiographs (AP and Water’s views): complete opacification or any mucosal thickening | USA | Moderate |
| Autio et al,32 2015 | Adults (n = 50) presenting to a military clinic with clinically suspected ARS of <4 days duration (symptoms recorded at 9-10 days after onset) | Mean 20 y, range 18-23 y | CT followed by antral puncture and bacterial culture if positive | Finland | Low |
AP = anteroposterior; ARS = acute rhinosinusitis; CT = computed tomography; ED = emergency department; ENT = ear, nose, and throat; IQ = interquartile; USA = United States of America; VA = Veterans Administration.