Clinical decision support system RHINA in the diagnosis and treatment of acute or chronic rhinosinusitis

L Hart,A Polášková,P Schalek

doi:10.1186/s12911-021-01599-3

Abstract

BackgroundRhinosinusitis is an inflammation of the sinonasal cavity which affects roughly one in seven people per year. Acute rhinosinusitis (ARS) is mostly, apart from allergic etiology, caused by a viral infection and, in some cases (30–50%), by a bacterial superinfection. Antibiotics, indicated only in rare cases according to EPOS guidelines, are nevertheless prescribed in more than 80% of ARS cases, which increases the resistant bacterial strains in the population.MethodsWe have designed a clinical decision support system (CDSS), RHINA, based on a web application created in HTML 5, using JavaScript, jQuery, CCS3 and PHP scripting language. The presented CDSS RHINA helps general physicians to decide whether or not to prescribe antibiotics in patients with rhinosinusitis.ResultsIn a retrospective study of a total of 1465 patients with rhinosinusitis, the CDSS RHINA presented a 90.2% consistency with the diagnosis and treatment made by the ENT specialist.ConclusionPatients assessed with the assistance of our CDSS RHINA would decrease the over-prescription of antibiotics, which in turn would help to reduce the bacterial resistance to the most commonly prescribed antibiotics.

Highlights

Rhinosinusitis is an inflammation of the sinonasal cavity which affects roughly one in seven people per year
In patients with acute symptoms, symptomatic decongestive therapy was indicated in 53.9% of patients (335 patients—common cold), enriched with intranasal corticoid in 29.9% (186 patients—postviral rhinosinusitis) and antibiotics were prescribed to 16.2% of patients (101 patients—purulent rhinosinusitis) (Additional file 1: Fig. S3)
The cost of usage of the clinical decision support system (CDSS) application can be reduced and its accessibility increased in low income communities through mobile phone-based applications, which is the aim of our future study

Summary

Introduction

Rhinosinusitis is an inflammation of the sinonasal cavity which affects roughly one in seven people per year. Acute rhinosinusitis (ARS) is mostly, apart from allergic etiology, caused by a viral infection and, in some cases (30–50%), by a bacterial superinfection. The term rhinosinusitis refers to an inflammation of the sinuses and nasal cavity which, according to histopathological findings and current imaging methods, occur simultaneously [1]. This disease of the upper respiratory tract affects roughly one in seven people per year and it has a significant impact on the quality of life and productivity of the individuals affected [2]. The most common of such bacteria are S. pneumoniae, H. influenzae, S. aureus and M. catarrhalis [6] Despite these findings, ARS is commonly treated with antibiotics worldwide. Differentiating diagnoses between viral and bacterial ARS has become a challenge, rendering the decision of physicians of whether to prescribe antibiotics more difficult [9]

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