title: May chronic rhinosinusitis in children be diagnosed by clinical symptoms?
abstract: OBJECTIVE
  Chronic rhinosinusitis (CRS) is a common disease in childhood but is often underdiagnosed because the symptoms are subtle and similar to other nasal pathologies. No clinical symptom is pathognomonic, and consensus documents suggest nasal fibroendoscopy (NF) or imaging criteria (computed tomography, magnetic resonance imaging) as the gold standards for diagnosis of CRS. However, considering the frequent unavailability of such tools to physicians, we designed this study to evaluate whether combinations of symptoms may achieve a clinical diagnosis of CRS in children as confirmed by NF.
  
  
  METHODS
  The study population consisted of 275 children with a clinical diagnosis of CRS, in 228 of whom diagnosis of CRS was confirmed by NF, while in 47 diagnosis was not confirmed by NF and they served as the control group. The symptoms considered were nasal obstruction, nasal discharge, cough, facial pain, and halitosis, using for statistical analysis multivariate logistic regression, Wald tests, and receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  The multivariate logistic regression for CRS symptoms indicated rhinorrea as the strongest predictor of CRS. With three symptoms the probability of CRS was from 60% to 75% without rhinorrea and 77-91% in the presence of this symptom, with four symptoms the probability was over 93%, and with all the five symptoms the probability of having CRS was virtually 100%.
  
  
  CONCLUSIONS
  These findings suggest that an initial symptoms assessment may help to recognize children with a high probability of CRS, thus reducing the need of NF or imaging techniques.
authors.affiliation: Pediatric Allergy and Respiratory Pathophysiology Unit, Vittore Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Milan, Italy. Electronic address: gualtiero.leo@icp.mi.it.
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Leo
authors.affiliation: Allergy, Pulmonary Rehabilitation Unit, Istituti Clinici di Perfezionamento, Milan, Italy.
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Incorvaia
authors.affiliation: Department of Pediatric Otorhinolaryngology, Vittore Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cazzavillan
authors.affiliation: Epidemiology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
mesh_terms: D002648:Child; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012220:Rhinitis / Q000175:diagnosis*; D012852:Sinusitis / Q000175:diagnosis*; D063189:Symptom Assessment
keywords: Children; Chronic rhinosinusitis; Imaging; Nasal fibroendoscopy; Symptoms