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. (2022-07-28)
Takada, T., Hoogland, J., Hansen, J. G., Lindbaek, M., Autio, T., Alho, O.-P., Ebell, M. H., Reitsma, J. B., & Venekamp, R. P. (2022). Diagnostic prediction models for CT-confirmed and bacterial rhinosinusitis in primary care: Individual participant data meta-analysis. British Journal of General Practice, 72(721), e601–e608. https://doi.org/10.3399/BJGP.2021.0585
© The Authors. This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
https://creativecommons.org/licenses/by/4.0/
https://urn.fi/URN:NBN:fi-fe202301265975
Tiivistelmä
Abstract
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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