Leo Gualtiero, Incorvaia Cristoforo, Cazzavillan Alessandro, Consonni Dario
Pediatric Allergy and Respiratory Pathophysiology Unit, Vittore Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Milan, Italy.
Allergy, Pulmonary Rehabilitation Unit, Istituti Clinici di Perfezionamento, Milan, Italy.
Int J Pediatr Otorhinolaryngol. 2015 Jun;79(6):825-828. doi: 10.1016/j.ijporl.2015.03.011. Epub 2015 Mar 23.
Chronic rhinosinusitis (CRS) is a common disease in childhood but is often underdiagnosed because the symptoms are subtle and similar to other nasal pathologies. No clinical symptom is pathognomonic, and consensus documents suggest nasal fibroendoscopy (NF) or imaging criteria (computed tomography, magnetic resonance imaging) as the gold standards for diagnosis of CRS. However, considering the frequent unavailability of such tools to physicians, we designed this study to evaluate whether combinations of symptoms may achieve a clinical diagnosis of CRS in children as confirmed by NF.
The study population consisted of 275 children with a clinical diagnosis of CRS, in 228 of whom diagnosis of CRS was confirmed by NF, while in 47 diagnosis was not confirmed by NF and they served as the control group. The symptoms considered were nasal obstruction, nasal discharge, cough, facial pain, and halitosis, using for statistical analysis multivariate logistic regression, Wald tests, and receiver operating characteristic (ROC) curve.
The multivariate logistic regression for CRS symptoms indicated rhinorrea as the strongest predictor of CRS. With three symptoms the probability of CRS was from 60% to 75% without rhinorrea and 77-91% in the presence of this symptom, with four symptoms the probability was over 93%, and with all the five symptoms the probability of having CRS was virtually 100%.
These findings suggest that an initial symptoms assessment may help to recognize children with a high probability of CRS, thus reducing the need of NF or imaging techniques.
慢性鼻-鼻窦炎（CRS）是儿童常见疾病，但常因症状不明显且与其他鼻腔疾病相似而诊断不足。没有任何临床症状具有诊断特异性，共识文件建议将鼻纤维内镜检查（NF）或影像学标准（计算机断层扫描、磁共振成像）作为CRS诊断的金标准。然而，考虑到医生经常无法获得此类工具，我们开展了本研究，以评估症状组合是否能实现对儿童CRS的临床诊断，且该诊断能得到NF的证实。
研究人群包括275例临床诊断为CRS的儿童，其中228例经NF证实为CRS，47例经NF未证实为CRS，这47例作为对照组。所考虑的症状包括鼻塞、流涕、咳嗽、面部疼痛和口臭，采用多因素逻辑回归、Wald检验和受试者工作特征（ROC）曲线进行统计分析。
CRS症状的多因素逻辑回归表明流涕是CRS最强的预测因素。有三种症状时，无流涕情况下CRS的概率为60%至75%，有流涕时为77%至91%；有四种症状时，概率超过93%；有所有五种症状时，患CRS的概率几乎为100%。
这些发现表明，初步症状评估可能有助于识别CRS高概率儿童，从而减少对NF或影像学技术的需求。
