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Postgraduate Medical Journal 2001;77:778-782; doi:10.1136/pmj.77.914.778
© 2001 BMJ Publishing Group Ltd and The Fellowship of Postgraduate Medicine.
Postgrad Med J 2001;77:778-782 ( December )

Determinants for the course of acute sinusitis in adult general practice patients

W A B Stalman, G A van Essen, Y van der Graaf

Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, P O Box 85060, 3508 AB Utrecht, The Netherlands

Correspondence and reprint requests to: Professor Stalman wstalman{at}knmg.nl

Submitted 23 February 2001; Accepted 30 May 2001

BACKGROUND---Although the prognosis of acute sinusitis is important, little is known about it and the factors predicting its course in a general practice population.
OBJECTIVE---To determine the course of acute sinusitis and factors predicting it in adults in general practice.
METHODS---The prognostic value of demographic and clinical factors and the patient's emotional state, for example anxious or depressed, were determined prospectively by means of multivariate analysis.
MAIN OUTCOME MEASUREMENTS---Resolution of facial pain, resumption of daily activities, and the patient's reported improvement. Factors with a significant predictive value were used to classify the patients into three different groups: quick, moderate, and slow recovery.
RESULTS---The median time from enrolment to recovery was six (range percentile 25-75: 4-10) days in a population of 177 patients. Factors predictive of a prolonged clinical course were: female sex (hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.42 to 0.83), history longer than 14 days before inclusion (HR 0.62; 95% CI 0.41 to 0.94), headache, cold, or cough as a reason for the encounter (HR 0.65; 95% CI 0.44 to 0.96), and absence of cervical adenopathy (HR 0.71; 95% CI 0.51 to 0.96). Antibiotic treatment did not influence the course of disease. The median time to recovery was three days for patients with a quick, five days for those with a moderate, and seven days for those with a slow recovery.
CONCLUSION---In general practice acute sinusitis is mostly a self limiting disease. A limited number of characteristics are predictive of a (slightly) prolonged clinical course of acute sinusitis in general practice.


Keywords: acute sinusitis; family practice

© 2001 by The Fellowship of Postgraduate Medicine
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