{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:01:20Z","timestamp":1771480880235,"version":"3.50.1"},"reference-count":29,"publisher":"Royal College of General Practitioners","issue":"721","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Antibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To develop prediction models for computed tomography (CT)-confirmed ARS and culture-confirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>This was a systematic review and individual participant data meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>CT-confirmed ARS was defined as the presence of fluid level or total opacification in any maxillary sinuses, whereas culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 426 patients from three studies, 140 patients (32.9%) had CT-confirmed ARS. A model consisting of seven variables: previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by a physician, and C-reactive protein (CRP) showed an optimism-corrected c-statistic of 0.73 (95% confidence interval [CI] = 0.69 to 0.78) and a calibration slope of 0.99 (95% CI = 0.72 to 1.19). Among 225 patients from two studies, 68 patients (30.2%) had culture-confirmed ABRS. A model consisting of three variables: pain in teeth, purulent nasal discharge, and CRP showed an optimism-corrected c-statistic of 0.70 (95% CI = 0.63 to 0.77) and a calibration slope of 1.00 (95% CI = 0.66 to 1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Simple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp.2021.0585","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T12:10:23Z","timestamp":1653048623000},"page":"e601-e608","source":"Crossref","is-referenced-by-count":7,"title":["Diagnostic prediction models for CT-confirmed and bacterial rhinosinusitis in primary care: individual participant data meta-analysis"],"prefix":"10.3399","volume":"72","author":[{"given":"Toshihiko","family":"Takada","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroen","family":"Hoogland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens G","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten","family":"Lindbaek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Autio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olli-Pekka","family":"Alho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark H","family":"Ebell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes B","family":"Reitsma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roderick P","family":"Venekamp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1987","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"2022072817254221000_72.721.e601.1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin20.600"},{"key":"2022072817254221000_72.721.e601.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"2022072817254221000_72.721.e601.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006245"},{"key":"2022072817254221000_72.721.e601.4","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2354"},{"issue":"2","key":"2022072817254221000_72.721.e601.5","doi-asserted-by":"crossref","first-page":"e180243","DOI":"10.1001\/jamanetworkopen.2018.0243","article-title":"Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons","volume":"1","author":"Havers","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2022072817254221000_72.721.e601.6","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dku005"},{"key":"2022072817254221000_72.721.e601.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c2096"},{"key":"2022072817254221000_72.721.e601.8","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.140848"},{"key":"2022072817254221000_72.721.e601.9","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2060"},{"issue":"3","key":"2022072817254221000_72.721.e601.10","first-page":"183","article-title":"Use of symptoms, signs, and blood tests to diagnose acute sinus infections in primary care: comparison with computed tomography","volume":"28","author":"Lindbaek","year":"1996","journal-title":"Fam Med"},{"key":"2022072817254221000_72.721.e601.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.313.7053.325"},{"issue":"7","key":"2022072817254221000_72.721.e601.12","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1002\/lary.25247","article-title":"Diagnostic accuracy of history and physical examination in bacterial acute rhinosinusitis","volume":"125","author":"Autio","year":"2015","journal-title":"Laryngoscope"},{"key":"2022072817254221000_72.721.e601.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.6999.233"},{"issue":"9","key":"2022072817254221000_72.721.e601.14","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1007\/BF02743149","article-title":"Brief report: a red streak in the lateral recess of the oropharynx predicts acute sinusitis","volume":"21","author":"Thomas","year":"2006","journal-title":"J Gen Intern Med"},{"key":"2022072817254221000_72.721.e601.15","doi-asserted-by":"publisher","DOI":"10.3109\/13814789509161629"},{"key":"2022072817254221000_72.721.e601.16","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7992"},{"key":"2022072817254221000_72.721.e601.17","doi-asserted-by":"publisher","DOI":"10.1177\/962280218784726"},{"key":"2022072817254221000_72.721.e601.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-040988"},{"key":"2022072817254221000_72.721.e601.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19163"},{"key":"2022072817254221000_72.721.e601.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.3656"},{"key":"2022072817254221000_72.721.e601.21","doi-asserted-by":"publisher","DOI":"10.1059\/0003-4819-155-8-201110180-00009"},{"key":"2022072817254221000_72.721.e601.22","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-9-57"},{"key":"2022072817254221000_72.721.e601.23","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5732"},{"key":"2022072817254221000_72.721.e601.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.01.020"},{"key":"2022072817254221000_72.721.e601.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2014.06.018"},{"key":"2022072817254221000_72.721.e601.26","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2331"},{"key":"2022072817254221000_72.721.e601.27","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814561600"},{"key":"2022072817254221000_72.721.e601.28","unstructured":"National Institute for Health and Care Excellence (2017) Sinusitis (acute): antimicrobial prescribing (NICE, London) https:\/\/www.nice.org.uk\/guidance\/ng79 (accessed 5 Jul 2022)."},{"key":"2022072817254221000_72.721.e601.29","doi-asserted-by":"crossref","unstructured":"Ebell MH Locatelli I Mueller Y (2018) Diagnosis and treatment of community-acquired pneumonia in patients with acute cough: a quantitative study of decision thresholds in primary care. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp18X699545.","DOI":"10.3399\/bjgp18X699545"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2021.0585","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:27:48Z","timestamp":1659054468000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2021.0585"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,20]]},"references-count":29,"journal-issue":{"issue":"721","published-online":{"date-parts":[[2022,7,28]]},"published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.3399\/BJGP.2021.0585"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2021.0585","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,20]]}}}