title: Inconclusive evidence that age predicts a prolonged or chronic course of acute rhinosinusitis in adults: a systematic review of the evidence base.
abstract: OBJECTIVE
  To review the evidence whether the risk for a prolonged or chronic course increases with age in adult patients with acute rhinosinusitis.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane Library.
  
  
  METHODS
  A comprehensive literature search was performed on March 24, 2013, and articles were screened and selected using predefined inclusion and exclusion criteria. Articles reporting studies on age as a predictor for the course in patients with acute rhinosinusitis were included. For included articles, the design of reported studies was assessed for directness of evidence and risk of bias. We aimed to extract hazard ratios for age as a continuous variable.
  
  
  RESULTS
  Out of 13,382 unique publications, 3 articles with moderate risk of bias were included, with a maximum follow-up period of 30 days. The reported hazard ratios for recovery at 10, 15, and 30 days are 1.0 (95% confidence interval, 0.9-1.1) for age as a continuous variable, 0.86 (0.66-1.11) for age dichotomized at 38 years, and 0.58 (0.40-0.84) for age dichotomized for an increase with 20 years, respectively.
  
  
  CONCLUSIONS
  There is no evidence that age increases the risk for chronic rhinosinusitis in adult patients with acute rhinosinusitis. The literature is inconclusive that age increases the risk for a prolonged course of acute rhinosinusitis and, therefore, does not provide grounds for different management according to age of patients. As such, patients can be managed according to clinical practice guidelines with expectant observation and symptomatic treatment.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Timo P
authors.initials: TP
authors.lastname: Broeder
authors.forename: Karina V
authors.initials: KV
authors.lastname: Grooteman
authors.forename: Sanne B
authors.initials: SB
authors.lastname: Overdijkink
authors.forename: Christel E
authors.initials: CE
authors.lastname: Selhorst
authors.forename: Nina M
authors.initials: NM
authors.lastname: Kaper
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D018450:Disease Progression; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D009017:Morbidity / Q000639:trends; D012220:Rhinitis / Q000453:epidemiology*; D012307:Risk Factors; D012852:Sinusitis / Q000453:epidemiology*; D013997:Time Factors
keywords: acute rhinosinusitis; age; chronic rhinosinusitis; evidence-based medicine; prognosis; prolonged rhinosinusitis