Validation of EPOS 2012 Disease Control Assessment in Chronic Rhinosinusitis

Abstract

Objectives:

1) Validate a clinical staging system on disease “control” in chronic rhinosinusitis (CRS) proposed by the European Position Paper on Rhinosinusitis (EPOS) 2) Propose a new, data driven staging system.

Methods:

Prospective study over a 12-month period of CRS patients who underwent endoscopic sinus surgery in tertiary care. The Sinonasal Outcome Test-22 and endoscopy score along with patient’s and physician’s report on clinical progress were recorded at 6 and 12 months. Ordinal regression was used for modeling symptoms and endoscopic findings to build up “disease control” criteria. Patients were defined as either “controlled,” “partly controlled,” or “uncontrolled” according to both EPOS and proposed criteria. The agreements with physician’s and patient’s report were analyzed.

Results:

106 patients were assessed (49.1% female, age 49.0±13.9yrs). Nasal obstruction was the only symptom which predicted patient’s report (maximum likelihood (ML) -3.6, P = 0.02). Mucosal inflammation (ML -2.4, P < 0.001) and thick and/or purulent discharge (ML-2.5, P = 0.01) predicted physician’s report. A new “NOSE” staging system of nasal obstruction, systemic medication used, and endoscopic inflammation was proposed. EPOS system had fair agreement (k 0.29, P < 0.001) with physician’s and slight agreement (k 0.18, P = 0.01) with patient’s report, while the NOSE system had better agreement with both physician’s (k 0.40, P < 0.01) and patient’s report (k 0.32, P < 0.01). Both systems predicted treatment outcome at 12 months (both, P < 0.05).

Conclusions:

The disease control assessment by EPOS staging system has slight agreement with patients and physicians. A new system using nasal obstruction, diseased mucosa, and discharge is proposed.