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The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict?
Claire Hopkins1, John P Browne, Rob Slack
1Clinical Effectiveness Unit, Royal College of Surgeons of England, London. clairehopkins@yahoo.com
Objectives:
The Lund-Mackay score is widely used in assessment of chronic rhinosinusitis. We aimed to describe its relationship to other measures of pre- and post-treatment health status.
Study Design:
Multicenter prospective study of 1840 patients undergoing surgery for chronic rhinosinusitis in the UK.
Results:
There was no absolute threshold for surgery, but patients with higher Lund-Mackay scores underwent more extensive surgery. There was no correlation between Lund-Mackay and SNOT-22 scores. The Lund-Mackay increased with increasing grade of polyposis. The Lund-Mackay score was associated with symptom reduction (coefficient = 0.24, P = 0.02) complication rates (odds ratio, 1.08, 95%CI 1.06 to 1.1), and revision rates (odds ratio, 1.03, 95% CI 1.001 to 1.06).
Conclusions:
The Lund-Mackay score measures a different aspect of disease to "subjective" symptom scores. However, it correlates well with other markers of disease severity, the nature of surgery offered, and its outcome.
Significance:
This demonstrates the strengths and limitations of a commonly used staging system.
