title: Factors associated with computed tomography status in patients presenting with a history of chronic rhinosinusitis.
abstract: BACKGROUND
  The diagnosis of chronic rhinosinusitis (CRS) is based upon symptomatic criteria and objective measures. However, patients suspected to have CRS based on a positive history but negative endoscopies remain a diagnostic challenge. We investigated the utility of point of care computed tomography (POC-CT) in resolving this issue.
  
  
  METHODS
  The study group consisted of a simple random sample of 100 patients presenting with active CRS symptoms and negative endoscopies who underwent POC-CT at initial presentation. Presenting symptoms and comorbidities were correlated with CT scan results (positive/negative) using univariate and multivariate logistic regression models.
  
  
  RESULTS
  POC-CT was considered positive in 49% of patients. Univariate analysis revealed that patients complaining nasal obstruction were significantly more likely to have a positive scan (odds ratio [OR], 2.74; p = 0.047), while those with postnasal drip (OR, 0.44; p = 0.047) or cough (OR, 0.17; p = 0.03) were less likely to have positive scan results. In the multivariate model, these trends persisted without reaching statistical significance. Under univariate analysis, patients who were prescribed antibiotics, oral steroids, or nasal steroids at this initial visit were more likely to have had a positive CT. These trends also persisted in the multivariate model, with significance observed for the association between antibiotic prescription and a positive scan (p = 0.001).
  
  
  CONCLUSIONS
  Less than 50% of patients with active CRS symptoms had radiographic manifestations of sinus disease. Other etiologies must be considered higher in the differential for those presenting primarily with complaints referable to the throat. POC-CT averted unnecessary antibiotics in these patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Leah J
authors.initials: LJ
authors.lastname: Abrass
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Chandra
authors.forename: David B
authors.initials: DB
authors.lastname: Conley
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Tan
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kern
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012220:Rhinitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids