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Diagnosing Sinusitis
- Alvah R. Cass, MD;
- Scott B. Cantor, PhD; and
- Richard D. Clover, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Williams and colleagues [1] concluded that five clinical findings can help predict the probability of sinusitis for a male patient experiencing sinus symptoms. Their methods carefully avoided verification and expectation biases and measured observer agreement. However the generalizability of the study results is more restricted than the authors suggest. Men with a median age of 50 years enrolled from a university-affiliated Veterans Affairs medical center are not representative of a general medical or primary care population.
The study's prevalence of 38% is much higher than that in one epidemiologic study where sinusitis complicated 0.5% of upper respiratory tract infections [2]. Enrolling patients with symptoms lasting up to 3 months may have resulted in the inclusion of persons with chronic sinusitis. Misclassification of patients with chronic sinusitis might have been avoided by re-evaluating patients 3 to 6 weeks after the initial diagnosis and eliminating or separately analyzing patients whose radiographs were unimproved. Allergic rhinitis frequently coexists with sinusitis [3], and acute radiographic changes consistent with sinusitis have been documented after nasal challenge with inhalant allergens [4]. We agree that sinus aspiration could not be applied, but use of a surrogate criterion standard behooves the authors to eliminate misclassifications.
Although the authors are not offering a clinical prediction rule, the statistical analysis should have included a validation process, either a verification cohort or the employment of bootstrap or jackknife methods [5].
Alvah R. Cass, MD
Scott B. Cantor, PhD
Richard D. Clover, MD
The University of Texas Medical Branch at Galveston; Galveston, TX 77555-0853
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
