TY - JOUR
T1 - The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis
AU - Bhattacharyya, Neil
AU - Jones, Dwight T.
AU - Hill, Micah
AU - Shapiro, Nina L.
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2004/9
Y1 - 2004/9
N2 - Objective: To determine the accuracy of computed tomography (CT) in the diagnosis of pediatric chronic rhinosinusitis (CRS). Settings: Multi-institutional prospective dual cohort study. Methods: Two cohorts of children undergoing CT of the paranasal sinuses were prospectively evaluated. The first cohort consisted of children undergoing CT in preparation for endoscopic sinus surgery (diseased group). The second cohort consisted of children undergoing CT for non-sinusitis reasons (nondiseased control group). Sinus CT scans were scored according to the Lund-MacKay system. Diagnostic accuracy was quantified with the receiver operating characteristic curve. Sensitivity, specificity, and predictive value analyses were conducted. Results: A total of 66 pediatric patients (mean age, 8 years) were studied in the diseased group and exhibited a mean Lund score of 10.4 (95% confidence interval, 9.2-11.5); 192 control patients (mean age, 9 years) exhibited a mean Lund score of 2.8 (95% confidence interval, 2.4-3.2). The area under the curve for the receiver operating characteristic was 0.923 (P<.001), indicating excellent diagnostic accuracy. Adopting a Lund score cut-off of 5 to represent true disease, the CT scan demonstrated a sensitivity and specificity of 86% and 85%, respectively. Lund scores of 2 or less have an excellent negative predictive value, whereas Lund scores of 5 or greater have an excellent positive predictive value (ie, strongly indicate true disease). Conclusions: The sinus CT scan demonstrates excellent diagnostic accuracy for the diagnosis of pediatric CRS, with excellent sensitivity and specificity. However, its predictive value depends substantially on the base rate prevalence of CRS in the population being evaluated.
AB - Objective: To determine the accuracy of computed tomography (CT) in the diagnosis of pediatric chronic rhinosinusitis (CRS). Settings: Multi-institutional prospective dual cohort study. Methods: Two cohorts of children undergoing CT of the paranasal sinuses were prospectively evaluated. The first cohort consisted of children undergoing CT in preparation for endoscopic sinus surgery (diseased group). The second cohort consisted of children undergoing CT for non-sinusitis reasons (nondiseased control group). Sinus CT scans were scored according to the Lund-MacKay system. Diagnostic accuracy was quantified with the receiver operating characteristic curve. Sensitivity, specificity, and predictive value analyses were conducted. Results: A total of 66 pediatric patients (mean age, 8 years) were studied in the diseased group and exhibited a mean Lund score of 10.4 (95% confidence interval, 9.2-11.5); 192 control patients (mean age, 9 years) exhibited a mean Lund score of 2.8 (95% confidence interval, 2.4-3.2). The area under the curve for the receiver operating characteristic was 0.923 (P<.001), indicating excellent diagnostic accuracy. Adopting a Lund score cut-off of 5 to represent true disease, the CT scan demonstrated a sensitivity and specificity of 86% and 85%, respectively. Lund scores of 2 or less have an excellent negative predictive value, whereas Lund scores of 5 or greater have an excellent positive predictive value (ie, strongly indicate true disease). Conclusions: The sinus CT scan demonstrates excellent diagnostic accuracy for the diagnosis of pediatric CRS, with excellent sensitivity and specificity. However, its predictive value depends substantially on the base rate prevalence of CRS in the population being evaluated.
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U2 - 10.1001/archotol.130.9.1029
DO - 10.1001/archotol.130.9.1029
M3 - Article
C2 - 15381587
AN - SCOPUS:4444272623
VL - 130
SP - 1029
EP - 1032
JO - JAMA Otolaryngology - Head and Neck Surgery
JF - JAMA Otolaryngology - Head and Neck Surgery
SN - 2168-6181
IS - 9
ER -