title: No evidence for distinguishing bacterial from viral acute rhinosinusitis using fever and facial/dental pain: a systematic review of the evidence base.
abstract: OBJECTIVE
  To assess the diagnostic value of fever and facial and dental pain in adults suspected of acute bacterial rhinosinusitis.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane Library.
  
  
  METHODS
  A comprehensive systematic search was performed on March 18, 2013. We included articles reporting studies on the diagnostic value of fever or facial and dental pain in patients suspected of acute bacterial rhinosinusitis. For included articles, the reported study design was assessed for directness of evidence and risk of bias. Prevalences, positive predictive values, and negative predictive values were extracted.
  
  
  RESULTS
  Of 3171 unique records, we included 1 study with a high directness of evidence and a moderate risk of bias. The prior probability of bacterial rhinosinusitis was 0.29 (95% confidence interval: 0.24 to 0.35). We could not extract posterior probabilities with accompanying positive and negative predictive values. The study reported an odds ratio from univariate analysis for fever of 1.02 (0.52 to 2.00) and 1.65 (0.83 to 3.28) for facial and dental pain. In subsequent multivariate analysis, the odds ratio of facial and dental pain was 1.86 (1.06 to 3.29).
  
  
  CONCLUSIONS
  There is 1 study with moderate risk of bias, reporting data in such a manner that we could not assess the value of fever and facial and dental pain in adults suspected of an acute bacterial rhinosinusitis. Therefore, these symptoms should not be used in clinical practice to distinguish between a bacterial and viral source of acute rhinosinusitis or for decision making about prescribing antibiotic treatment.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Allard J
authors.initials: AJ
authors.lastname: Hauer
authors.forename: Eric L
authors.initials: EL
authors.lastname: Luiten
authors.forename: Nicole F
authors.initials: NF
authors.lastname: van Erp
authors.forename: Peter E
authors.initials: PE
authors.lastname: Blase
authors.forename: Mark C J
authors.initials: MC
authors.lastname: Aarts
authors.forename: Nina M
authors.initials: NM
authors.lastname: Kaper
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
mesh_terms: D000208:Acute Disease; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis*; D019317:Evidence-Based Medicine; D005157:Facial Pain / Q000209:etiology*; D005260:Female; D005334:Fever; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012220:Rhinitis / Q000175:diagnosis*; D012852:Sinusitis / Q000175:diagnosis*; D014098:Toothache / Q000209:etiology*; D014777:Virus Diseases / Q000175:diagnosis*
keywords: acute bacterial rhinosinusitis; acute rhinosinusitis; acute viral rhinosinusitis; diagnosis; evidence-based medicine; facial/dental pain; fever