The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis

Neil Bhattacharyya, Dwight T. Jones, Micah Hill, Nina L. Shapiro

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1029-1032
Number of pages4
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume130
Issue number9
DOIs
StatePublished - Sep 1 2004

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Tomography
Pediatrics
Sensitivity and Specificity
ROC Curve
Confidence Intervals
Paranasal Sinuses
Area Under Curve
Cohort Studies
Control Groups
Population

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis. / Bhattacharyya, Neil; Jones, Dwight T.; Hill, Micah; Shapiro, Nina L.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 130, No. 9, 01.09.2004, p. 1029-1032.

Research output: Contribution to journalArticle

Bhattacharyya, Neil ; Jones, Dwight T. ; Hill, Micah ; Shapiro, Nina L. / The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis. In: Archives of Otolaryngology - Head and Neck Surgery. 2004 ; Vol. 130, No. 9. pp. 1029-1032.
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abstract = "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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