tailieunhanh - Clinical practice guideline: Adult sinusitis

Guidelines are never intended to supersede profes- sional judgment; rather, they may be viewed as a relative constraint on individual clinician discretion in a particu- lar clinical circumstance. Less frequent variation in prac- tice is expected for a strong recommendation than might be expected with a recommendation. Options offer the most opportunity for practice variability. 30 Clinicians should always act and decide in a way that they believe will best serve their patients’ interests and needs, regard- less of guideline recommendations. Guidelines represent the best judgment of a team of experienced clinicians and methodologists addressing the scientific evidence for a particular topic. . | Otolaryngology-Head and Neck Surgery 2007 137 S1-S31 GUIDELINES Clinical practice guideline Adult sinusitis Richard M. Rosenfeld MD MPH David Andes MD Neil Bhattacharyya MD Dickson Cheung MD MBA MPH-C Steven Eisenberg MD Theodore G. Ganiats MD Andrea Gelzer MD MS Daniel Hamilos MD Richard C. Haydon III MD Patricia A. Hudgins MD Stacie Jones MPH Helene J. Krouse PhD Lawrence H. Lee MD Martin C. Mahoney MD PhD Bradley F. Marple MD Col. John P. Mitchell MC MD Robert Nathan MD Richard N. Shiffman MD mCiS Timothy L. Smith MD MPH and David L. Witsell MD MHS Brooklyn NY Madison WI Boston MA Baltimore MD Edina MN San Diego CA Hartford CT Lexington KY Atlanta GA Alexandria VA Detroit MI Buffalo NY Dallas TX Wright-Patterson AFB OH Denver CO New Haven CT Portland OR and Durham NC OBJECTIVE This guideline provides evidence-based recommendations on managing sinusitis defined as symptomatic inflammation of the paranasal sinuses. Sinusitis affects 1 in 7 adults in the United States resulting in about 31 million individuals diagnosed each year. Since sinusitis almost always involves the nasal cavity the term rhinosinusitis is preferred. The guideline target patient is aged 18 years or older with uncomplicated rhinosinusitis evaluated in any setting in which an adult with rhinosinusitis would be identified monitored or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with sinusitis. PURPOSE The primary purpose of this guideline is to improve diagnostic accuracy for adult rhinosinusitis reduce inappropriate antibiotic use reduce inappropriate use of radiographic imaging and promote appropriate use of ancillary tests that include nasal endoscopy computed tomography and testing for allergy and immune function. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of allergy emergency medicine family medicine health insurance immunology infectious .