Accuracy of Signs and Symptoms of ABRS Diagnosed by Purulent Antral Puncture or Positive Bacterial Culture
| Sign or Symptom | # of Studies | Sensitivity (95% CI) | Sensitivity (95% CI) | LR+ (95% CI)a | LR− (95% CI)a | DOR (95% CI)b |
|---|---|---|---|---|---|---|
| Overall clinical impression | 3 | 0.74 (0.61-0.84) | 0.80 (0.72-0.87) | 3.9 (2.4-5.9)c | 0.33 (0.20-0.50)c | 13.0 (5.0-27)c |
| Symptoms | ||||||
| Cacosmiad | 3 | 0.23 (0.11-0.42) | 0.93 (0.59-0.99) | 4.3 (0.94-14) | 0.86 (0.76-0.99)c | 5.0 (0.74-18) |
| Pain in teeth | 3 | 0.38 (0.10-0.78) | 0.80 (0.37-0.97) | 2.0 (1.1-3.7)c | 0.77 (0.50-0.96)c | 2.7 (1.3-4.6)c |
| Purulent nasal discharge | 3 | 0.64 (0.45-0.79) | 0.50 (0.36-0.63) | 1.3 (0.99-1.6) | 0.74 (0.47-1.0) | 1.8 (0.98-3.2) |
| Pain bending forward | 3 | 0.64 (0.4-0.79) | 0.38 (0.20-0.60) | 1.0 (0.87-1.3) | 0.95 (0.69-1.3) | 1.2 (0.69-1.8) |
| Nasal congestion or obstruction | 4 | 0.71 (0.57-0.82) | 0.25 (0.10-0.52) | 0.98 (0.83-1.3) | 1.3 (0.70-2.3) | 0.88 (0.38-1.8) |
| Cough | 3 | 0.66 (0.34-0.86) | 0.29 (0.12-0.55) | 0.93 (0.70-1.1) | 1.2 (0.79-1.7) | 0.84 (0.45-1.4) |
| Physical examination | ||||||
| Sinus tenderness, maxillary | 5 | 0.33 (0.13-0.61) | 0.57 (0.40-0.73) | 0.86 (0.23-2.2) | 1.2 (0.55-2.1) | 0.97 (0.11-3.9) |
| Nasal discharge, purulent | 5 | 0.27 (0.20-0.35) | 0.66 (0.45-0.82) | 0.88 (0.36-1.9) | 1.2 (0.57-1.8) | 0.83 (0.22-2.3) |
ABRS = acute rhinosinusitis; DOR = diagnostic odds ratio; LR+ = positive likelihood ratio; LR− = negative likelihood ratio.
Note: Each sign or symptom was reported in 3 or more studies to be included here.
↵a A likelihood ratio near 1.0 means that the test adds little diagnostic information, a likelihood ratio >1 increases the likelihood of disease, and a likelihood ratio <1 decreases the likelihood of disease.
↵b The diagnostic odds ratio is LR+ divided by LR− and is an overall measure of diagnostic discrimination.
↵c Value is significantly < or > 1.0.
↵d Cacosmia is fetid odor on patient’s breath.