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

Arch Otolaryngol Head Neck Surg. 2004;130:1029-1032.

Objective  To determine the accuracy of computed tomography (CT) in the diagnosis of pediatric chronic rhinosinusitis (CRS).

Setting  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 nonsinusitis 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 cutoff 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.

From the Division of Otolaryngology, Brigham and Women's Hospital (Dr Bhattacharyya) and Department of Otolaryngology, The Children's Hospital, and Department of Otology & Laryngology, Harvard Medical School (Dr Jones), Boston, Mass; Department of Otolaryngology, Stanford University Medical Center, Stanford, Calif (Dr Hill); and Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, California (Dr Shapiro). The authors have no relevant financial interest in this article.

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