患者报告的疾病控制情况与整体症状严重程度作为慢性鼻-鼻窦炎疾病状态的总体指标。
Patient-reported disease control versus overall symptom severity as global metrics of chronic rhinosinusitis disease status.
作者信息
Cotter Ryan A, Garcia Jack T, Alsayed Ahmed, Schneider Sven, Liu David T, Eckl-Dorna Julia, Houssein Firas A, Boparai Robby S, Parail Nikhil A, Chu Matthew M, Meier Josh C, Alsaleh Saad, Phillips Katie M, Sedaghat Ahmad R
机构信息
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Department of Otolaryngology--Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
出版信息
Int Forum Allergy Rhinol. 2025 Jan;15(1):27-35. doi: 10.1002/alr.23435. Epub 2024 Sep 13.
BACKGROUND
Overall symptom severity (OSS) and patient-reported chronic rhinosinusitis (CRS) control are global measures of CRS identified as consensus, essential criteria for CRS disease control assessment. We sought to determine the functional relationship between these two metrics.
METHODS
Using an international multicenter mixed-methods design, 260 CRS patients were recruited. OSS score was measured using a visual analog scale. Patient-reported CRS control was measured as "controlled," "partly controlled," and "uncontrolled." Twelve participants underwent semi-structured interviews to discuss OSS and patient-reported CRS control.
RESULTS
The majority of interviewed participants felt OSS and patient-reported CRS control measured different constructs-while OSS only measured symptoms, patient-reported CRS control was more global, including not only symptom severity but also concepts such as medication usage, activity impairment, and exacerbations. Nevertheless, OSS score was strongly correlated with (ρ = 0.67, p < 0.001) and highly predictive of patient-reported CRS control. OSS score of >4 (95% confidence interval [CI]: 1.8-4.2) had 74.7% sensitivity and 93.2% specificity in identifying patients reporting their CRS as not controlled. OSS score of >6.6 (95% CI: 4.1-7.1) had 77.0% sensitivity and 75.9% specificity in identifying patients reporting their CRS as uncontrolled. The 22-item Sinonasal Outcome Test score was also predictive of patient-reported CRS disease control but OSS was significantly more predictive.
CONCLUSIONS
Patients conceptually view patient-reported CRS control as a more global measure that subsumes OSS. Quantitatively, however, OSS is highly correlated with patient-reported CRS control, possibly reflecting their redundancy. For ease of use, we recommend patient-reported CRS control be reflected by OSS <4 for controlled, 4 ≤ OSS < 7 for partly controlled, and OSS ≥7 for uncontrolled CRS.
背景
总体症状严重程度（OSS）和患者报告的慢性鼻-鼻窦炎（CRS）控制情况是CRS的整体指标，被确定为CRS疾病控制评估的共识性基本标准。我们试图确定这两个指标之间的功能关系。
方法
采用国际多中心混合方法设计，招募了260例CRS患者。使用视觉模拟量表测量OSS评分。将患者报告的CRS控制情况分为“控制良好”“部分控制”和“未控制”。12名参与者接受了半结构化访谈，以讨论OSS和患者报告的CRS控制情况。
结果
大多数接受访谈的参与者认为OSS和患者报告的CRS控制衡量的是不同的概念——OSS仅衡量症状，而患者报告的CRS控制更具整体性，不仅包括症状严重程度，还包括药物使用、活动受限和病情加重等概念。然而，OSS评分与患者报告的CRS控制情况密切相关（ρ = 0.67，p < 0.001），并且对其具有高度预测性。OSS评分>4（95%置信区间[CI]：1.8 - 4.2）在识别报告CRS未得到控制的患者时，灵敏度为74.7%，特异度为93.2%。OSS评分>6.6（95%CI：4.1 - 7.1）在识别报告CRS未得到控制的患者时，灵敏度为77.0%，特异度为75.9%。22项鼻鼻窦结局测试评分也可预测患者报告的CRS疾病控制情况，但OSS的预测性明显更强。
结论
患者从概念上认为患者报告的CRS控制是一个更具整体性的指标，其中包含了OSS。然而，从定量角度来看，OSS与患者报告的CRS控制情况高度相关，这可能反映了它们的冗余性。为便于使用，我们建议将患者报告的CRS控制情况按以下方式反映：OSS <4为控制良好，4≤OSS <7为部分控制，OSS≥7为未控制的CRS。
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