{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:45:22Z","timestamp":1792277122495,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,8,5]],"date-time":"2013-08-05T00:00:00Z","timestamp":1375660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives\/Hypothesis<\/jats:title>\n                    <jats:p>To diagnose chronic rhinosinusitis (CRS), current guidelines require either endoscopic or computed tomography (CT) findings of sinus disease. To a primary care physician, this means a referral to an otolaryngologist or obtaining a CT scan. Unfortunately, the sensitivity of endoscopy for detecting CRS is low, and examination by the Otolaryngologist may not yield a definitive diagnosis. This leaves CT scanning. However, this is contradicted by recommendations to limit CT scanning for only preoperative planning purposes due to cost concerns. This study aims to provide an evidence\u2010based cost\u2010efficient recommendation for primary care practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Health care economics\u2010based decision analysis model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cost\u2010based decision analysis based on literature\u2010reported probabilities and Medicare costs was constructed for two scenarios: 1) primary care physicians who are comfortable initiating first\u2010line treatment for chronic rhinosinusitis, rhinitis, and atypical facial pain; and 2) primary care physicians who are less comfortable with medical management of these conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Under both scenarios and the extremes of sensitivity analysis, upfront CT scanning provides cost\u2010efficient diagnosis over presuming a diagnosis of chronic rhinosinusitis. Primary care physicians who attempt first\u2010line treatment can expect $503 (range\u2009=\u2009$296\u2013$761) saved per patient. Meanwhile, primary care physicians who prefer to refer may expect $326 (range\u2009=\u2009$299\u2013$353) saved per patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In all scenarios, confirming diagnosis with CT scanning prior to treatment or referral is more cost\u2010efficient than presuming a diagnosis of CRS based on symptoms alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      2c.\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 124:12\u201318, 2014\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.24100","type":"journal-article","created":{"date-parts":[[2013,8,8]],"date-time":"2013-08-08T13:43:16Z","timestamp":1375969396000},"page":"12-18","source":"Crossref","is-referenced-by-count":29,"title":["Primary care and upfront computed tomography scanning in the diagnosis of chronic rhinosinusitis: A cost\u2010based decision analysis"],"prefix":"10.1002","volume":"124","author":[{"given":"Randy M.","family":"Leung","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh K.","family":"Chandra","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Kern","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Conley","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce K.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,8,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2007.06.726"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3132\/pcrj.2008.00029"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2010.04.012"},{"key":"e_1_2_6_5_1","unstructured":"American College of Radiology.ACR appropriateness criteria: sinonasal disease.2009. 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