Hopkins Claire, Rudmik Luke, Lund Valerie J
Department of Otolaryngology, Guy's and St. Thomas' National Health Service Trust, London, United Kingdom.
Division of Otolaryngology-Head and Neck Surgery, Richmond Road Diagnostic and Treatment Centre, University of Calgary, Calgary, Alberta, Canada.
Laryngoscope. 2015 Aug;125(8):1779-84. doi: 10.1002/lary.25318. Epub 2015 Apr 17.
OBJECTIVES/HYPOTHESIS: With the aim of facilitating preference-sensitive decision making regarding elective endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS), we set out to evaluate the predictive value of the 22-item Sinonasal Outcome Test (SNOT-22) patient-reported outcome measure and to compare outcomes of a UK cohort with a similar United States/Canadian-based study.
Prospective observational cohort study,
Patients electing ESS in 87 UK hospitals were enrolled. The primary outcome was change in SNOT-22 score 3 months after surgery. Patients were categorized according to baseline SNOT-22 score, and the proportion of patients achieving a SNOT-22 minimal clinically important difference (MCID) of 8.9 was calculated, as well as the percentage change in SNOT-22 score.
A total of 2,263 patients were included within this study. There was an average 40% reduction in SNOT-22 scores following surgery, and 66% of patients overall achieved the MCID. The proportion of patients achieving the MCID increased significantly with increasing baseline SNOT-22. Patients with a preoperative score of <20 failed to achieve a mean improvement greater than the MCID. Patients with a score of >30 had a greater than 70% chance of achieving the MCID. CRS patients with polyps had greater improvement than patients with CRS without polyps. The predictive value of the SNOT-22 is similar in the UK cohort, although overall patients did not benefit from surgery as much as their North American counterparts.
Medically recalcitrant patients with CRS considering surgery should make decisions guided by their preoperative quality-of-life impairment, as measured by the SNOT-22.
2b
目的/假设：为了促进关于慢性鼻窦炎（CRS）的选择性鼻内镜鼻窦手术（ESS）的偏好敏感型决策制定，我们着手评估22项鼻鼻窦结局测试（SNOT-22）患者报告结局指标的预测价值，并将英国队列的结果与一项类似的基于美国/加拿大的研究进行比较。
前瞻性观察性队列研究。
纳入在87家英国医院选择接受ESS的患者。主要结局是术后3个月SNOT-22评分的变化。根据基线SNOT-22评分对患者进行分类，计算达到SNOT-22最小临床重要差异（MCID）为8.9的患者比例，以及SNOT-22评分的百分比变化。
本研究共纳入2263例患者。术后SNOT-22评分平均降低40%，总体66%的患者达到MCID。达到MCID的患者比例随基线SNOT-22评分的增加而显著增加。术前评分<20的患者未能实现大于MCID的平均改善。评分>30的患者实现MCID的机会大于70%。伴有息肉的CRS患者比不伴有息肉的CRS患者改善更大。SNOT-22在英国队列中的预测价值相似，尽管总体而言患者从手术中获得的益处不如北美同行。
考虑手术的药物治疗无效的CRS患者应根据术前生活质量损害情况（通过SNOT-22测量）来做出决策。
2b
