Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography.
OBJECTIVE
To establish the incidence of maxillary sinusitis in general practice and the predictive value of symptoms and signs.


METHODS
Population based study.


METHODS
9 general practices with 15,220 patients aged 15 years and older on the list.


METHODS
400 patients with 441 episodes in whom practitioners intended to confirm or to exclude sinusitis.


METHODS
Results of ultrasonography and signs and symptoms associated with positive results.


RESULTS
212 of the 441 episodes were confirmed by ultrasonography. 15.7 episodes occurred per 1000 adults per year. The five symptoms beginning with common cold (beta coefficient = 1.035), purulent rhinorrhoea (0.996), pain at bending (0.950), unilateral maxillary pain (0.640), and pain in teeth (0.606) were associated with positive results on ultrasonography. General practitioners' clinical diagnoses were correct in 177 episodes, false positive in 88, false negative in 22, and uncertain in 154. With an algorithm using the five weighted symptoms 243 of the diagnoses would have been correct, but 110 would remain uncertain and 44 cases would have been missed.


CONCLUSIONS
The five symptoms algorithm would improve diagnostic accuracy of general practitioners, but incorrect and uncertain diagnoses cannot be avoided.
van Duijn
N P
NP
Department of General Practice, University of Amsterdam, Netherlands.
Brouwer
H J
HJ
Lamberts
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D003139:Common Cold / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008875:Middle Aged; D009297:Nasal Mucosa / Q000378:metabolism; D010146:Pain / Q000209:etiology; D011237:Predictive Value of Tests; D012141:Respiratory Tract Infections / Q000175:diagnosis; D012220:Rhinitis / Q000175:diagnosis; D014463:Ultrasonography