Determinants for the course of acute sinusitis in adult general practice patients

Background-Although the prognosis of acute sinusitis is important, little i s known about it and the factors predicting its course in a general practic e population. Objective-To determine the course of acute sinusitis and factors predicting it in adults in general practice. Methods-The prognostic value of demographic and clinical factors and the pa tient's emotional state, for example anxious or depressed, were determined prospectively by means of multivariate analysis. Main outcome measurements-Resolution of facial pain, resumption of daily ac tivities, and the patient's reported improvement. Factors with a significan t predictive value were used to classify the patients into three different groups: quick, moderate, and slow recovery. Results-The median time from enrolment to recovery was six (range percentil e 25-75: 4-10) days in a population of 177 patients. Factors predictive of a prolonged clinical course were: female sex (hazard ratio (HR) 0.60; 95% c onfidence interval (Cl) 0.42 to 0.83), history longer than 14 days before i nclusion (HR 0.62; 95% Cl 0.41 to 0.94), headache, cold, or cough as a reas on for the encounter (HR 0.65; 95% CI 0.44 to 0.96), and absence of cervica l adenopathy (HR 0.71; 95% Cl 0.51 to 0.96). Antibiotic treatment did not i nfluence the course of disease. The median time to recovery,was three days for patients with a quick, five days for those with a moderate, and seven d ays for those with a slow recovery. Conclusion-In general practice acute sinusitis is mostly a self limiting di sease. A limited number of characteristics are predictive of a (slightly) p rolonged clinical course of acute sinusitis in general practice.