Article type
Year
Abstract
Objective: To assess the effectiveness of clinical examination, radiography and ultrasound as compared to a diagnostic reference standard for acute maxillary sinusitis.
Methods: Systematic review and meta-analysis of comparative studies identified through Medline, ancestry searches, hand searches, and personal contacts. Studies were included if they compared two or more diagnostic methods in adults with a suspected acute maxillary sinusitis and no tests were performed before applying the methods under study. Articles in English, German, French, Scandinavian languages, and Finnish were included. We excluded studies on chronic sinusitis or otherwise selected patient populations. The validity criteria proposed by the Cochrane Collaboration Methods Working Group on Diagnosis and Screening were applied. Studies comparing each diagnostic method to a given reference standard were pooled to produce summary-ROC-curves and odds ratios.
Results: Since 1962, 37 study reports were found; 11 studies with a total of 1464 patients fulfilled the quality criteria. Radiography was most accurate in diagnosing acute sinusitis when puncture was used as the gold standard (summary OR 16.7, 95% CI 10.4-26.8). The results of ultrasound diagnosis were less uniform: ultrasound rated worse compared to sinus puncture (5.9, 95% CI 4.0-8.7) than to radiography (11.5, 95% CI 7.3-18.3). Clinical examination had a low summary OR (6.2, 95% CI 4.3-8.8). An updated review with additional eligible studies will be available for the Colloquium.
Discussion: Most diagnostic studies were of low methodological quality; none reported actual patient outcomes. Clinical examination was an unreliable method for diagnosing acute maxillary sinusitis in unselected patient populations. The use of radiography improved diagnostic accuracy and is recommended if the correct diagnosis is considered important. The effectiveness of ultrasound varied. The poorest results were achieved in primary care settings where the prevalence of sinusitis was low. More rigorous research on the effectiveness of diagnostic methods for sinusitis is needed, and the effect of the diagnostic method on patient outcomes should be included in these evaluations.
Methods: Systematic review and meta-analysis of comparative studies identified through Medline, ancestry searches, hand searches, and personal contacts. Studies were included if they compared two or more diagnostic methods in adults with a suspected acute maxillary sinusitis and no tests were performed before applying the methods under study. Articles in English, German, French, Scandinavian languages, and Finnish were included. We excluded studies on chronic sinusitis or otherwise selected patient populations. The validity criteria proposed by the Cochrane Collaboration Methods Working Group on Diagnosis and Screening were applied. Studies comparing each diagnostic method to a given reference standard were pooled to produce summary-ROC-curves and odds ratios.
Results: Since 1962, 37 study reports were found; 11 studies with a total of 1464 patients fulfilled the quality criteria. Radiography was most accurate in diagnosing acute sinusitis when puncture was used as the gold standard (summary OR 16.7, 95% CI 10.4-26.8). The results of ultrasound diagnosis were less uniform: ultrasound rated worse compared to sinus puncture (5.9, 95% CI 4.0-8.7) than to radiography (11.5, 95% CI 7.3-18.3). Clinical examination had a low summary OR (6.2, 95% CI 4.3-8.8). An updated review with additional eligible studies will be available for the Colloquium.
Discussion: Most diagnostic studies were of low methodological quality; none reported actual patient outcomes. Clinical examination was an unreliable method for diagnosing acute maxillary sinusitis in unselected patient populations. The use of radiography improved diagnostic accuracy and is recommended if the correct diagnosis is considered important. The effectiveness of ultrasound varied. The poorest results were achieved in primary care settings where the prevalence of sinusitis was low. More rigorous research on the effectiveness of diagnostic methods for sinusitis is needed, and the effect of the diagnostic method on patient outcomes should be included in these evaluations.