An evaluation of diagnosis and treatment of acute sinusitis at three health care centers

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: The objective of this study was to evaluate the diagnosis and treatment of acute sinusitis at three health care centers in northern and eastern Iceland. MATERIAL AND METHODS: Information on all those diagnosed with acute sinusitis (ICD 10 J01.0, J01.9) in the year 2004 at the communal health care centers in Akureyri, Husavik and Egilsstadir was obtained retrospectively from computerized clinical records. Key factors used for diagnosis and treatment were recorded. In order to obtain an equal distribution in population size only about one-third of the diagnoses made in Akureyri were included in the search (the first ten days of every month). RESULTS: The search yielded a total of 468 individuals. The average incidence of acute sinusitis was found to be 3.4 per 100 inhabitants per year. Adherence to clinical guidelines (albeit from other countries) regarding diagnosis of bacterial sinusitis was nearly nonexistent. There were considerable differences found between health care centers as to whether x-rays were used for diagnostic purposes. Blood tests were hardly used at all. The disease was diagnosed over the telephone in 28% of the cases (Husavik 38%, Akureyri 32%, Egilsstadir 10%). Over 90% of all individuals diagnosed with acute sinusitis received antibiotics, regardless of symptom duration. The antibiotics most often prescribed were Doxycyclin and Amoxicillin. CONCLUSIONS: The incidence of acute sinusitis in these three communities seems to be similar to other western countries. Acute bacterial sinusitis seems to be overdiagnosed and the use of antibiotics is in no context with clinical guidelines. Our results support the hypothesis that physicians tend to regard acute sinusitis as a bacterial disease, and treat it accordingly.Tilgangur: Tilgangur rannsóknarinnar var að meta greiningu og meðferð bráðrar skútabólgu á þremur heilsugæslustöðvum á Norður- og Austurlandi, með áherslu á sýklalyfjanotkun. Aðferðir og efniviður: Gerð var leit í SÖGU að þeim sem greindust með bráða skútabólgu (ICD 10 J01.0, J01.9) á heilsugæslustöðvunum á Akureyri, Egilsstöðum og Húsavík árið 2004. Síðan voru allir viðkomandi samskiptaseðlar skoðaðir og lykilatriði við greiningu og meðferð skráð. Til að fá sem jafnasta dreifingu á fjölda var einungis þriðjungur tilfella á Akureyri tekinn með í reikninginn (fyrstu tíu dagar hvers mánaðar). Upplýsingasöfnun fór fram í febrúar 2006. Niðurstöður: Heildarfjöldi tilfella var 468. Nýgengi bráðrar skútabólgu mældist 3,4 á hverja 100 íbúa á ári. Fylgni við greiningarskilmerki bakteríuskútabólgu samkvæmt erlendum klínískum leiðbeiningum var lítil. Mikill munur kom í ljós milli staða í notkun myndgreiningar (Húsavík 24%, Akureyri 6%, Egilsstaðir 3%). Sjúkdómurinn var greindur í gegnum síma í 28% tilvika (Húsavík 38%, Akureyri 32%, Egilsstaðir 10%). Yfir 90% greindra voru meðhöndluð með sýklalyfjum, óháð tímalengd einkenna. Oftast voru notuð sýklalyfin doxýcýklín (36,7%) og amoxicillín (36,7%). Ályktanir: Nýgengi bráðrar skútabólgu virðist sambærilegt því sem gerist í öðrum vestrænum löndum. Bráð skútabólga af völdum baktería er sennilega ofgreind, og notkun sýklalyfja er úr öllu samhengi við klínískar leiðbeiningar. Niðurstöðurnar styðja þá tilgátu að læknar hneigist til að líta á bráða skútabólgu sem bakteríusýkingu og meðhöndli hana í samræmi við það

An evaluation of diagnosis and treatment of acute sinusitis at three health care centers

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: The objective of this study was to evaluate the diagnosis and treatment of acute sinusitis at three health care centers in northern and eastern Iceland. MATERIAL AND METHODS: Information on all those diagnosed with acute sinusitis (ICD 10 J01.0, J01.9) in the year 2004 at the communal health care centers in Akureyri, Husavik and Egilsstadir was obtained retrospectively from computerized clinical records. Key factors used for diagnosis and treatment were recorded. In order to obtain an equal distribution in population size only about one-third of the diagnoses made in Akureyri were included in the search (the first ten days of every month). RESULTS: The search yielded a total of 468 individuals. The average incidence of acute sinusitis was found to be 3.4 per 100 inhabitants per year. Adherence to clinical guidelines (albeit from other countries) regarding diagnosis of bacterial sinusitis was nearly nonexistent. There were considerable differences found between health care centers as to whether x-rays were used for diagnostic purposes. Blood tests were hardly used at all. The disease was diagnosed over the telephone in 28% of the cases (Husavik 38%, Akureyri 32%, Egilsstadir 10%). Over 90% of all individuals diagnosed with acute sinusitis received antibiotics, regardless of symptom duration. The antibiotics most often prescribed were Doxycyclin and Amoxicillin. CONCLUSIONS: The incidence of acute sinusitis in these three communities seems to be similar to other western countries. Acute bacterial sinusitis seems to be overdiagnosed and the use of antibiotics is in no context with clinical guidelines. Our results support the hypothesis that physicians tend to regard acute sinusitis as a bacterial disease, and treat it accordingly.Tilgangur: Tilgangur rannsóknarinnar var að meta greiningu og meðferð bráðrar skútabólgu á þremur heilsugæslustöðvum á Norður- og Austurlandi, með áherslu á sýklalyfjanotkun. Aðferðir og efniviður: Gerð var leit í SÖGU að þeim sem greindust með bráða skútabólgu (ICD 10 J01.0, J01.9) á heilsugæslustöðvunum á Akureyri, Egilsstöðum og Húsavík árið 2004. Síðan voru allir viðkomandi samskiptaseðlar skoðaðir og lykilatriði við greiningu og meðferð skráð. Til að fá sem jafnasta dreifingu á fjölda var einungis þriðjungur tilfella á Akureyri tekinn með í reikninginn (fyrstu tíu dagar hvers mánaðar). Upplýsingasöfnun fór fram í febrúar 2006. Niðurstöður: Heildarfjöldi tilfella var 468. Nýgengi bráðrar skútabólgu mældist 3,4 á hverja 100 íbúa á ári. Fylgni við greiningarskilmerki bakteríuskútabólgu samkvæmt erlendum klínískum leiðbeiningum var lítil. Mikill munur kom í ljós milli staða í notkun myndgreiningar (Húsavík 24%, Akureyri 6%, Egilsstaðir 3%). Sjúkdómurinn var greindur í gegnum síma í 28% tilvika (Húsavík 38%, Akureyri 32%, Egilsstaðir 10%). Yfir 90% greindra voru meðhöndluð með sýklalyfjum, óháð tímalengd einkenna. Oftast voru notuð sýklalyfin doxýcýklín (36,7%) og amoxicillín (36,7%). Ályktanir: Nýgengi bráðrar skútabólgu virðist sambærilegt því sem gerist í öðrum vestrænum löndum. Bráð skútabólga af völdum baktería er sennilega ofgreind, og notkun sýklalyfja er úr öllu samhengi við klínískar leiðbeiningar. Niðurstöðurnar styðja þá tilgátu að læknar hneigist til að líta á bráða skútabólgu sem bakteríusýkingu og meðhöndli hana í samræmi við það

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201