Probability of Acute Bacterial Sinusitis
 

Williams, J. W., Jr., D. L. Simel, et al. (1992).
"Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination."
Ann Intern Med 117(9): 705-10.

Important CPR Information
Maxillary Toothache
History of colored nasal discharge
No improvement with decongestants
Abnormal transillumination
Purulent secretions on examination

 

Probability of acute sinusitis:
 
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Critical Appraisal of CPR
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  1. Outcome: Sinusitis
    • Definition: 4 radiographic views showing air fluid level, or mucous membrane thickening of at least 6mm.
    • Prevelance: 38%
    • Blinded assessment
    • Potential weakness: Actual gold standard is sinus aspiration with bacteriologic culture.
    • Potential weakness: CT may be more sensitive, but is less specific.
  2. Predictive Variables
    • Assessed the sensitivity/specificty of 16 symptoms and 5 signs.
    • Blind assessment
  3. Patient Population
    • 247 consecutive male patients, median age=50 years, median duration of symptoms=11.5 days.
    • Inclusion criteria: facial pain (not related to trauma), nasal discharge, or self-suspected sinusitis.
    • Exclusion criteria: symptoms > 3 months, external beam radiation therapy, current chemotherapy, malignacy, HIV, oral corticosteroid use within 3 months, acute facial or head trauma, previous sinus surgery.
  4. Description of Study Site
    • General Medical Clinic, Walk-In Clinic, and the Employee Health Clinic at the Durham Veteran Affairs Medical Center, North Carolina
  5. Prospective Validation: No
    • Derived only: Level 4
  6. Impact Analysis: No
  7. Mathematical Techniques Described
    • logistic regression
  8. Results of the Clinical Decision Rule
    9. PredictorOdds Ratio
    maxillary toothache2.9
    abnormal transillumination2.7
    poor response to decongestants2.4
    purulent secretions2.9
    colored nasal discharge by history2.2
  9. Reproducibility
    Predictor kappa
    colored nasal discharge0.68
    maxillary toothache0.60
    abnormal transillumination 0.22
    purulent secretions 0.14
  10. Sensibility: Yes
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