The role of point-of-care CT in the management of chronic rhinosinusitis: A case-control study

Point-of-care computed tomography (POC-CT) has become more feasible since the introduction of smaller imaging devices that deliver lower radiation doses. As the availability of this modality continues to increase, its impact on diagnostic and therapeutic algorithms in patients with chronic rhinosinusitis (CRS) must be evaluated. We conducted a study of 40 consecutively presenting new patients who (1) met the symptom criteria for CRS but whose endoscopy results were negative (i.e., no pus, polyps, or edema), (2) had not undergone any previous CT scanning or sinus surgery, and (3) had undergone POC-CT during their initial evaluation. A comparison group was made up of 40 patients from the pre-POC-CT era whose initial treatment had been based on the history alone; these patients underwent CT after their medical therapy had been completed. In the pre-POC-CT group, follow-up CT showed evidence of inflammatory disease in 24 patients (60%), 13 of whom (54.2%) had received an antibiotic at their initial visit, including 2 who had received an oral steroid, as well; among the 16 patients whose follow-up CT was negative, only 2 (12.5%) had received an antibiotic, neither of whom received an oral steroid. In the POC-CT group, 27 of 40 patients (67.5%) had positive findings at the initial visit, and 14 of them (51.9%) received an antibiotic and an oral steroid; none of the 13 patients in whom POC-CT was negative was prescribed either agent. Thus, the incidence of scan positivity and antibiotic use was similar in the two cohorts. Also, patients who met the symptomatic definition of CRS but who were lacking in objective endoscopic findings were more likely to have received an oral steroid when POC-CT was part of the initial assessment; these patients were also less likely to be lost to follow-up. Ongoing prospective studies will better characterize the magnitude of these effects on long-term outcomes, antibiotic resistance, healthcare costs, and overall quality of care.