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Development of a clinically relevant endoscopic grading system for chronic rhinosinusitis using canonical correlation
Adam S DeConde1, Todd E Bodner2, Jess C Mace3
1Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, San Diego, CA.
International Forum of Allergy & Rhinology
|December 19, 2015
Summary
A weighted endoscopic scale significantly improves the correlation between sinonasal inflammation and patient symptoms in chronic rhinosinusitis (CRS). This new scale better predicts symptom burden by combining endoscopic findings like polyps and edema.
Area of Science:
- Otolaryngology
- Rhinology
- Medical Informatics
Background:
- Chronic rhinosinusitis (CRS) diagnosis relies on sinonasal inflammation assessment via nasal endoscopy.
- Existing staging systems show inconsistent links between endoscopic findings and patient-reported symptoms.
- There's a need for a refined endoscopic scale to accurately predict symptom severity in CRS.
Purpose of the Study:
- To identify key endoscopic attributes correlating with symptom burden in CRS patients.
- To develop a weighted endoscopic scale for optimized prediction of concurrent symptoms.
Main Methods:
- Prospective cohort study involving 629 CRS patients.
- Collected baseline symptom data using the 22-item Sino-Nasal Outcome Test (SNOT-22).
- Utilized canonical correlation analysis to link SNOT-22 subdomains with Lund-Kennedy (LK) endoscopic scores.
Main Results:
- Canonical correlations explained significantly more variance (33%) than aggregate correlations (3%).
- The strongest correlation linked rhinologic symptoms with polyp score (r=0.54).
- Additional correlations found between extra-rhinologic symptoms and edema/discharge scores, varying by prior surgery status.
Conclusions:
- A weighted combination of endoscopic findings and symptom domains substantially enhances predictive accuracy.
- A proposed weighting ratio (polyps:edema:discharge:scarring:crusting) is approximately 4:2:1:0:0.
- This weighted scale offers improved correlation for assessing CRS symptom burden.
