Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis
| Autor: | Scott D. Hirsch, Wen Wan, Laurence J. DiNardo, Theodore A. Schuman, Evan R. Reiter |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
medicine.medical_specialty Comorbidity Sensitivity and Specificity Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Facial Pain Internal medicine medicine Prevalence Humans Sinusitis 030223 otorhinolaryngology Depression (differential diagnoses) Aged Pain Measurement Retrospective Studies Rhinitis Aged 80 and over medicine.diagnostic_test business.industry Chronic sinusitis Headache Retrospective cohort study Endoscopy Evidence-based medicine Middle Aged medicine.disease Surgery Otorhinolaryngology Chronic Disease Earache Anxiety medicine.symptom business Tomography X-Ray Computed 030217 neurology & neurosurgery |
| Zdroj: | The Laryngoscope. 127(5) |
| ISSN: | 1531-4995 |
| Popis: | Objective Determine whether the elimination of pain improves accuracy of clinical diagnostic criteria for adult chronic rhinosinusitis. Study Design Retrospective cohort study. Methods History, symptoms, nasal endoscopy, and computed tomography (CT) results were analyzed for 1,186 adults referred to an academic otolaryngology clinic with presumptive diagnosis of chronic rhinosinusitis. Clinical diagnosis was rendered using the 1997 Rhinosinusitis Taskforce (RSTF) Guidelines and a modified version eliminating facial pain, ear pain, dental pain, and headache. Results Four hundred seventy-nine subjects (40%) met inclusion criteria. Among subjects positive by RSTF guidelines, 45% lacked objective evidence of sinonasal inflammation by CT, 48% by endoscopy, and 34% by either modality. Applying modified RSTF diagnostic criteria, 39% lacked sinonasal inflammation by CT, 38% by endoscopy, and 24% by either modality. Using either abnormal CT or endoscopy as the reference standard, modified diagnostic criteria yielded a statistically significant increase in specificity from 37.1% to 65.1%, with a nonsignificant decrease in sensitivity from 79.2% to 70.3%. Analysis of comorbidities revealed temporomandibular joint disorder, chronic cervical pain, depression/anxiety, and psychiatric medication use to be negatively associated with objective inflammation on CT or endoscopy. Conclusion Clinical diagnostic criteria overestimate the prevalence of chronic rhinosinusitis. Removing facial pain, ear pain, dental pain, and headache increased specificity without a concordant loss in sensitivity. Given the high prevalence of sinusitis, improved clinical diagnostic criteria may assist primary care providers in more accurately predicting the presence of inflammation, thereby reducing inappropriate antibiotic use or delayed referral for evaluation of primary headache syndromes. Level of Evidence 4. Laryngoscope, 127:1011–1016, 2017 |
| Databáze: | OpenAIRE |
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