Do symptoms and initial clinical probability predict the radiological diagnosis of acute sinusitis in children?

Abstract

To evaluate the value of signs and symptoms in children for the radiological diagnosis of acute sinusitis. Prospective cohort study. University-affiliated tertiary care hospital. All children presenting with symptoms suggestive of acute sinusitis for whom sinus radiographs were ordered. Data were collected on the presence of specific symptoms and the initial probability of sinusitis. Criterion-based radiological diagnoses were made. Three hundred ninety-two consecutive children were seen; 257 children had a radiological diagnosis of acute sinusitis (66%), 128 patients (33%) presented with complete opacity of at least one sinus and 14 (4%) children had an air-fluid level. Sensitivity, specificity, predictive values and likelihood ratios were measured for clinical findings. Classical symptoms (rhinorrhea lasting more than 10 days and purulent rhinorrhea) increased the likelihood ratios the most (1.3 and 1.34, respectively). Logistic regression showed two independent predictors: purulent rhinorrhea (odds ratio 2.0) and the presence of acute otitis media (odds ratio 2.6). The initial clinical probability was more accurate than any other single finding: high probability (likelihood ratio 2.0), intermediate probability (likelihood ratio 1.1) and low probability (likelihood ratio 0.6). Classical symptoms are predictive of the presence of acute sinusitis as diagnosed on sinus radiographs. The physician's overall clinical impression, expressed as an initial probability, was superior to any single historical or examination finding in the diagnosis of acute sinusitis.