Accuracy of Signs and Symptoms of ARS Diagnosed by Any Reference Standard
| Sign or Symptom | # of Studies | Sensitivity (95% CI) | Specificity (95% CI) | LR+ (95% CI)a | LR− (95% CI)a | DOR (95% CI)b |
|---|---|---|---|---|---|---|
| Overall clinical impression | 4 | 0.73 (0.66-0.79) | 0.75 (0.64-0.84) | 3.0 (2.1-4.4)c | 0.37 (0.29-0.46)c | 8.3 (4.9-13.1)c |
| Symptoms | ||||||
| Nasal speech | 3 | 0.51 (0.15-0.85) | 0.73 (0.35-0.93) | 1.9 (1.3-2.7)c | 0.67 (0.37-0.91)c | 2.9 (1.8-4.3)c |
| Pain in teeth | 8 | 0.34 (0.21-0.50) | 0.80 (0.63-0.90) | 1.8 (1.2-2.5)c | 0.83 (0.74-0.90)c | 2.1 (1.4-3.0)c |
| Nasal discharge | ||||||
| Purulent | 10 | 0.71 (0.63-0.78) | 0.54 (0.48-0.61) | 1.6 (1.4-1.7)c | 0.54 (0.44-0.56)c | 2.9 (2.2-3.7)c |
| Any | 4 | 0.75 (0.57-0.91) | 0.49 (0.35-0.68) | 1.5 (1.3-1.8)c | 0.49 (0.24-0.82)c | 3.5 (1.7-6.2)c |
| Maxillary or frontal pain | 3 | 0.49 (0.15-0.83) | 0.63 (0.14-0.95) | 1.50 (0.86-3.50) | 0.89 (0.61-1.40) | 1.90 (0.61-4.50) |
| Maxillary pain | ||||||
| Unilateral | 5 | 0.30 (0.14-0.52) | 0.80 (0.51-0.94) | 1.50 (0.96-2.60) | 0.90 (0.79-1.00)c | 1.70 (0.92-3.00) |
| Location not specified | 5 | 0.70 (0.42-0.88) | 0.20 (0.05-0.51) | 0.88 (0.73-1.00)c | 1.60 (0.95-2.80) | 0.60 (0.30-1.10) |
| Cacosmiad | 5 | 0.23 (0.15-0.33) | 0.84 (0.58-0.95) | 1.50 (0.63-3.70) | 0.96 (0.83-1.20) | 1.70 (0.53-4.30) |
| Double sickening | 3 | 0.74 (0.32-0.95) | 0.41 (0.13-0.77) | 1.30 (0.77-2.40) | 0.69 (0.20-1.50) | 2.70 (0.49-8.50) |
| Hyposmia or anosmia | 8 | 0.61 (0.52-0.70) | 0.54 (0.46-0.61) | 1.3 (1.1-1.5)c | 0.72 (0.59-0.87)c | 1.9 (1.3-2.5)c |
| Cough | ||||||
| Nocturnal | 3 | 0.89 (0.80-0.94) | 0.11 (0.06-0.19) | 0.99 (0.87-1.10) | 1.20 (0.43-2.60) | 1.10 (0.35-2.60) |
| Any | 7 | 0.69 (0.57-0.80) | 0.40 (0.27-0.55) | 1.3 (1.0-1.7)c | 0.78 (0.60-0.98)c | 1.5 (1.0-2.2)c |
| Preceding respiratory tract infection | 5 | 0.87 (0.66-0.96) | 0.27 (0.13-0.48) | 1.2 (1.1 -1.3)c | 0.48 (0.30-0.72)c | 2.6 (1.6-4.0)c |
| Pain bending forward | 5 | 0.72 (0.56-0.84) | 0.39 (0.24-0.57) | 1.2 (1.0-1.5)c | 0.71 (0.50-0.97)c | 1.70 (0.97-2.70) |
| Nasal congestion or obstruction | 9 | 0.83 (0.74-0.89) | 0.24 (0.14-0.36) | 1.1 (1.0-1.2)c | 0.73 (0.56-0.93)c | 1.5 (1.1-2.1)c |
| Fatigue or malaise | 6 | 0.62 (0.51-0.71) | 0.45 (0.32-0.59) | 1.10 (0.99-1.30) | 0.86 (0.72-1.00)c | 1.30 (0.98-1.80) |
| Sneezing | 3 | 0.63 (0.49-0.74) | 0.39 (0.31-0.48) | 1.00 (0.86-1.20) | 0.96 (0.71-1.20) | 1.10 (0.70-1.20) |
| Headache | 6 | 0.50 (0.32-0.67) | 0.50 (0.27-0.73) | 1.00 (0.71-1.30) | 1.00 (0.79-1.40) | 1.00 (0.57-1.70) |
| Allergies by history | 3 | 0.19 (0.16-0.24) | 0.79 (0.72-0.85) | 0.96 (0.64-1.40) | 1.00 (0.93-1.10) | 0.96 (0.57-1.50) |
| Postnasal drip | 3 | 0.74 (0.55-0.87) | 0.19 (0.07-0.45) | 0.94 (0.73-1.30) | 1.50 (0.64-3.40) | 0.80 (0.23-2.00) |
| Previous sinusitis | 4 | 0.59 (0.52-0.65) | 0.27 (0.18-0.39) | 0.81 (0.71-0.93)c | 1.6 (1.1-2.2)c | 0.55 (0.33-0.83)c |
| Signs | ||||||
| Purulent secretions | ||||||
| Middle meatus | 5 | 0.15 (0.07-0.28) | 0.95 (0.87-0.98) | 3.2 (1.4-6.6)c | 0.90 (0.78-0.97)c | 3.7 (1.5-7.6)c |
| Pharyngeal or postnasal | 7 | 0.14 (0.06-0.30) | 0.92 (0.77-0.97) | 1.8 (1.1-2.8)c | 0.93 (0.87-0.98)c | 2.0 (1.2-3.1)c |
| Any nasal | 12 | 0.39 (0.28-0.51) | 0.74 (0.63-0.82) | 1.50 (0.99-2.30) | 0.84 (0.67-1.00)c | 1.90 (0.98-3.30) |
| Transillumination abnormal | 3 | 0.69 (0.63-0.75) | 0.56 (0.50-0.62) | 1.6 (1.4-1.9)c | 0.55 (0.44-0.67)c | 3.0 (2.0-4.2)c |
| Sinus tenderness | ||||||
| Frontal | 3 | 0.25 (0.09-0.54) | 0.75 (0.47-0.91) | 1.10 (0.76-1.40) | 0.99 (0.86-1.10) | 1.10 (0.70-1.60) |
| Maxillary | 12 | 0.44 (0.28-0.61) | 0.49 (0.34-0.64) | 0.88 (0.57-1.30) | 1.20 (0.80-1.60) | 0.81 (0.37-1.30) |
| Nasal mucosal thickening | 3 | 0.82 (0.27-0.98) | 0.30 (0.15-0.51) | 1.10 (0.49-1.40) | 0.68 (0.09-1.60) | 3.00 (0.32-13.00) |
| Temperature >38° C | 7 | 0.11 (0.07-0.19) | 0.87 (0.79-0.92) | 0.94 (0.42-1.90) | 1.00 (0.91-1.10) | 0.94 (0.37-2.10) |
ARS = 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.