Dr. Ebell's study: Sinusitis diagnosis in primary care
A US professor in epidemiology, Dr. Mark Ebell, has analysed studies of outpatients with a respiratory tract infection to see which diagnostic criteria were most accurate in diagnosing sinusitis. Antibiotics are typically prescribed for sinus infections, although in many cases antibiotics are not effective as the infection is not caused by bacteria. The present diagnostic methods are either invasive and unpleasant for the patient or inaccurate to support the decision about the antibiotic treatment. Dr. Ebell’s team analysed several studies of outpatients with upper respiratory tract infections and found out that some studies offered promising alternatives for detecting sinus infections and for supporting clinical decision-making. Point-of-care C-reactive protein tests are highlighted as promising in reducing the overuse of antibiotics. Dr. Ebell refers to European studies: “ There’ve been several studies in Europe showing that in the primary care setting, having the CRP results that show a patient is unlikely to have bacterial sinusitis, doctors are more confident about not using antibiotics and they’ve reduced inappropriate antibiotics use.” He also mentions ultrasound as an old method, which is making a come-back due to more accurate devices available presently.
Dr. Ebell concludes that their meta-analysis reinforced the idea that the imaging methods, such as X-ray and CT scans should not be used in diagnosing routine sinusitis unless there are complications. Instead physicians may consider ordering CRP tests. The study ‘Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy’, was published in the September issue of the British Journal of General Practice and is available online.
Br J Gen Pract. 2016 Sep;66(650):e612-32.