BMJ  1992;305:684-687 (19 September), doi:10.1136/bmj.305.6855.684

Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography.

Department of General Practice, University of Amsterdam, Netherlands.

OBJECTIVE--To establish the incidence of maxillary sinusitis in general practice and the predictive value of symptoms and signs. DESIGN--Population based study. SETTING--9 general practices with 15,220 patients aged 15 years and older on the list. PATIENTS--400 patients with 441 episodes in whom practitioners intended to confirm or to exclude sinusitis. MAIN OUTCOME MEASURES--Results of ultrasonography and signs and symptoms associated with positive results. RESULTS--212 of the 441 episodes were confirmed by ultrasonography. 15.7 episodes occurred per 1000 adults per year. The five symptoms beginning with common cold (beta coefficient = 1.035), purulent rhinorrhoea (0.996), pain at bending (0.950), unilateral maxillary pain (0.640), and pain in teeth (0.606) were associated with positive results on ultrasonography. General practitioners' clinical diagnoses were correct in 177 episodes, false positive in 88, false negative in 22, and uncertain in 154. With an algorithm using the five weighted symptoms 243 of the diagnoses would have been correct, but 110 would remain uncertain and 44 cases would have been missed. CONCLUSION--The five symptoms algorithm would improve diagnostic accuracy of general practitioners, but incorrect and uncertain diagnoses cannot be avoided.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Diagnosing maxillary sinusitis.

F. Dobbs and D. Fleming
BMJ 1992 305: 1435. [PDF]

Diagnosing maxillary sinusitis.

J. W. Fairley
BMJ 1992 305: 1223. [PDF]

Diagnosing maxillary sinusitis.

N. S. Jones
BMJ 1992 305: 1223. [PDF]

Diagnosing maxillary sinusitis.

M. Gleeson
BMJ 1992 305: 662-663. [PDF]

This article has been cited by other articles:

• Dobbs, F. (2009). Acute sinusitis in primary care. InnovAiT 2: 56-58 [Abstract] [Full text]  
• Williamson, I. G., Rumsby, K., Benge, S., Moore, M., Smith, P. W., Cross, M., Little, P. (2007). Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis: A Randomized Controlled Trial. JAMA 298: 2487-2496 [Abstract] [Full text]  
• Hickner, J. M., Bartlett, J. G., Besser, R. E., Gonzales, R., Hoffman, J. R., Sande, M. A. (2001). Principles of Appropriate Antibiotic Use for Acute Rhinosinusitis in Adults: Background. ANN INTERN MED 134: 498-505 [Abstract] [Full text]  
• Laupacis, A., Sekar, N., Stiell, l. G. (1997). Clinical Prediction Rules: A Review and Suggested Modifications of Methodological Standards. JAMA 277: 488-494 [Abstract]  
• Williams, J. W. Jr, Holleman, D. R. Jr, Samsa, G. P., Simel, D. L. (1995). Randomized Controlled Trial of 3 vs 10 Days of Trimethoprim/Sulfamethoxazole for Acute Maxillary Sinusitis. JAMA 273: 1015-1021 [Abstract]  
• Holleman, D. R. Jr, Williams, J. W. Jr, Simel, D. L. (1995). Usual Care and Outcomes in Patients With Sinus Complaints and Normal Results of Sinus Roentgenography. Arch Fam Med 4: 246-251 [Abstract]  
• van Duijn, N. P. (1994). Does This Patient Have Sinusitis?. JAMA 271: 501-502 [Abstract]  
• Williams, J. W. Jr, Simel, D. L. (1993). Does This Patient Have Sinusitis? Diagnosing Acute Sinusitis by History and Physical Examination. JAMA 270: 1242-1246 [Abstract]  

Online poll

Find out more here>> and here>>