TY - JOUR T1 - Diagnostic prediction models for computed tomography-confirmed acute rhinosinusitis and culture-confirmed acute bacterial rhinosinusitis in adults presenting to primary care: an individual participant data meta-analysis JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/BJGP.2021.0585 SP - BJGP.2021.0585 AU - Toshihiko Takada AU - Jeroen Hoogland AU - Jens G. Hansen AU - Morten Lindbaek AU - Timo Autio AU - Olli-Pekka Alho AU - Mark H. Ebell AU - Johannes B. Reitsma AU - Roderick P. Venekamp Y1 - 2022/05/19 UR - http://bjgp.org/content/early/2022/05/19/BJGP.2021.0585.abstract N2 - Background: Antibiotics are overused in patients with acute rhinosinusitis (ARS) since it is difficult to identify those who benefit from antibiotic treatment. Aim: To develop prediction models for computed tomography (CT)-confirmed ARS and culture-confirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS. Design and Setting: Systematic review and individual participant data meta-analysis. Method: CT-confirmed ARS was defined as presence of fluid level or total opacification in any maxillary sinuses, while culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling. Results: Among 426 patients from three studies, 140 patients (32.9%) had CT-confirmed ARS. A model consisting of seven variables (previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by physician, and C-reactive protein (CRP)) showed an optimism-corrected c-statistic of 0.73 (95% CI 0.69–0.78) and a calibration slope of 0.99 (95% CI 0.72–1.19). Among 225 patients from two studies, 68 patients (30.2%) had culture-confirmed ABRS. A model consisting of three variables (pain in teeth, purulent nasal discharge, and CRP) showed an optimism-corrected c-statistic of 0.70 (95% CI 0.63–0.77) and a calibration slope of 1.00 (95% CI 0.66–1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition. Conclusion: Simple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries. ER -