Ebell and Hansen developed a number of scores for evaluating an adult for acute rhinosinusitis in primary care. The authors are from the University of Georgia and Aarhus University Hospital in Denmark.
Patient selection: adult being evaluated for rhinosinusitis
Parameters:
(1) preceding upper respiratory tract infection (URTI)
(2) preceding sinusitis
(3) tender maxillary sinus, unilateral
(4) maxillary toothache
(5) purulent nasal discharge
(6) anosmia
(7) serum CRP in mg/L
These were used to generate 3 scores:
(1) when there were abnormal findings on CT scan
(2) when there was purulent fluid seen in antral puncture specimen
(3) when a culture of sinus fluid was positive
|
Parameter |
Finding |
Points |
|
preceding URTI |
no |
0 |
|
|
yes |
2 |
|
preceding sinusitis |
no |
0 |
|
|
yes |
-2 |
|
tender maxillary sinusitis |
no |
0 |
|
|
yes |
2 |
|
anosmia |
no |
0 |
|
|
yes |
1 |
|
CRP |
<= 15 mg/L |
0 |
|
|
> 15 mg/L |
4 |
score with abnormal CT finding =
= SUM(points for all 5 parameters)
|
Parameter |
Finding |
Points |
|
preceding URTI |
no |
0 |
|
|
yes |
1 |
|
preceding sinusitis |
no |
0 |
|
|
yes |
-2 |
|
tender maxillary sinusitis |
no |
0 |
|
|
yes |
1 |
|
maxillary toothache |
no |
0 |
|
|
yes |
1 |
|
CRP |
<= 15 mg/L |
0 |
|
|
> 15 mg/L |
3 |
score with abnormal antral puncture findings =
= SUM(points for all 5 parameters)
|
Parameter |
Finding |
Points |
|
preceding URTI |
no |
0 |
|
|
yes |
1 |
|
preceding sinusitis |
no |
0 |
|
|
yes |
-1 |
|
tender maxillary sinusitis |
no |
0 |
|
|
yes |
2 |
|
maxillary toothache |
no |
0 |
|
|
yes |
2 |
|
purulent nasal discharge |
no |
0 |
|
|
yes |
1 |
|
CRP |
<= 15 mg/L |
0 |
|
|
> 15 mg/L |
2 |
score with positive bacterial culture =
= SUM(points for all 6 parameters)
Interpretation:
• minimum abnormal CT score: -2
• minimum abnormal antral puncture score: -2
• minimum positive culture: -1
• maximum abnormal CT score: 9
• maximum abnormal antral puncture score: 6
• maximum positive culture: 8
• The higher the score the greater the risk of rhinosinutis.
|
Abnormal CT |
Abnormal Puncture |
Positive Culture |
Risk |
|
-2 to 1 |
-2 to 0 |
-1 to 3 |
low |
|
2 to 4 |
1 to 4 |
4 to 6 |
moderate |
|
5 to 9 |
5 or 6 |
7 to 8 |
high |
Performance:
• The area under the ROC curves: 0.75 for abnormal CT, 0.77 for antral puncture, 0.72 for positive bacterial culture.
Specialty: Otolaryngology, Infectious Diseases, Immunology/Rheumatology
