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Sinusitis Prediction Rule

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Sinusitis Prediction Rule, Williams Prediction Rule, Berg Prediction Rule, Task Force on Rhinosinusitis Prediction Rule, Clinical Prediction Rule for Diagnosis of Acute Bacterial Rhinosinusitis

  • See Also
  1. Acute Sinusitis
  2. Sinus Transillumination
  3. Acute Sinusitis Management
  • Indications
  1. Acute Sinusitis Evaluation
  • Protocol
  • Clinical Prediction Rule for Diagnosis of Acute Bacterial Rhinosinusitis
  1. Criteria
    1. Score 2: C-Reactive Protein >15 mg/dl
    2. Score 2: Maxillary Toothache
    3. Score 2: Purulent Nasal Drainage
    4. Score 2: Unilateral Tender Maxillary Sinus
    5. Score 1: Preceding respiratory tract infection
    6. Score -1: History of Rhinosinusitis
  2. Interpretation (total score -1 to 9)
    1. Total Score -1 to 3: Low Risk
      1. Likelihood of Acute Bacterial Rhinosinusitis: 16%
    2. Total Score 4 to 6: Moderate Risk
      1. Likelihood of Acute Bacterial Rhinosinusitis: 49%
    3. Total Score 7 to 8: High Risk
      1. Likelihood of Acute Bacterial Rhinosinusitis: 73%
  3. References
    1. Ebell (2017) Am Fam Med 15(4): 347-54 [PubMed]
  • Protocol
  • Williams and Berg Prediction Rules
  1. Criteria
    1. Maxillary Toothache
    2. Purulent nasal secretion
    3. History of colored Nasal Discharge
    4. Poor response to nasal Decongestants
    5. Abnormal Sinus Transillumination
  2. Modifiers
    1. Symptoms >7-10 days increases diagnostic efficacy
  3. Interpretation: Berg Prediction Rule
    1. Positive if 2 or more criteria positive
    2. Efficacy if symptoms present >7-10 days
      1. Positive Predictive Value: 80%
      2. Negative Predictive Value: 6%
    3. Berg (1988) Acta Otolaryngol 105:343-9 [PubMed]
  4. Interpretation: Williams Prediction Rule
    1. Positive if 4 or more criteria present
    2. Intermediate if 2 or 3 criteria present
      1. Study recommended sinus radiography
    3. Negative if <2 criteria present
  5. References
    1. Williams (1992) Ann Intern Med 117:705-10 [PubMed]
  • Protocol
  • Task Force on Rhinosinusitis Prediction Rule
  1. Major Criteria
    1. Nasal obstruction or blockage
    2. Postnasal discharge or Rhinorrhea
    3. Hyposmia or Anosmia
  2. Major Criteria need accompanying other major criteria
    1. Facial pain, pressure, or fullness
    2. Fever (Acute Rhinosinusitis)
  3. Minor Criteria
    1. Headaches
    2. Fever (Subacute, Chronic or Recurrent Sinusitis)
    3. Halitosis
    4. Fatigue
    5. Dental Pain
    6. Cough
    7. Ear Pain, pressure or fullness
  4. Interpretation: Positive for Acute Bacterial Sinusitis
    1. Two or more major criteria or
    2. One major criteria with two or more minor criteria or
    3. Nasal purulence seen on examination
  5. Reference
    1. Lanza (1997) Otolaryngol Head Neck Surg 117:S1-7 [PubMed]