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Diagnostic prediction models for CT-confirmed and bacterial rhinosinusitis in primary care: individual participant data meta-analysis.
Takada, Toshihiko; Hoogland, Jeroen; Hansen, Jens G; Lindbaek, Morten; Autio, Timo; Alho, Olli-Pekka; Ebell, Mark H; Reitsma, Johannes B; Venekamp, Roderick P.
Afiliación
  • Takada T; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; associate professor, Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.
  • Hoogland J; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  • Hansen JG; Department of Clinical Epidemiology, Aarhus University Hospital, Clinical Institute, Aarhus University, Aarhus, Denmark.
  • Lindbaek M; Department of General Practice, Institute of Health and Society, University Hospital of Oslo, Oslo, Norway.
  • Autio T; Head & Neck Surgery, Oulu University Hospital, Oulu, Finland.
  • Alho OP; PEDEGO Research Unit, University of Oulu, Finland; professor of otorhinolaryngology, Department of Otorhinolaryngology, Head & Neck Surgery, Oulu University Hospital, Oulu, Finland.
  • Ebell MH; Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, US.
  • Reitsma JB; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  • Venekamp RP; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Br J Gen Pract ; 72(721): e601-e608, 2022 08.
Article en En | MEDLINE | ID: mdl-35817585
BACKGROUND: Antibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment. AIM: To develop prediction models for computed tomography (CT)-confirmed ARS and culture-confirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS. DESIGN AND SETTING: This was a systematic review and individual participant data meta-analysis. METHOD: CT-confirmed ARS was defined as the presence of fluid level or total opacification in any maxillary sinuses, whereas culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling. RESULTS: Among 426 patients from three studies, 140 patients (32.9%) had CT-confirmed ARS. A model consisting of seven variables: previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by a physician, and C-reactive protein (CRP) showed an optimism-corrected c-statistic of 0.73 (95% confidence interval [CI] = 0.69 to 0.78) and a calibration slope of 0.99 (95% CI = 0.72 to 1.19). Among 225 patients from two studies, 68 patients (30.2%) had culture-confirmed ABRS. A model consisting of three variables: pain in teeth, purulent nasal discharge, and CRP showed an optimism-corrected c-statistic of 0.70 (95% CI = 0.63 to 0.77) and a calibration slope of 1.00 (95% CI = 0.66 to 1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition. CONCLUSION: Simple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sinusitis / Rinitis Tipo de estudio: Diagnostic_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Adult / Humans Idioma: En Revista: Br J Gen Pract Año: 2022 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sinusitis / Rinitis Tipo de estudio: Diagnostic_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Adult / Humans Idioma: En Revista: Br J Gen Pract Año: 2022 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Reino Unido