Development of the Sinus Headache Screener (SHS)

Facial pain or pressure is often non-rhinogenic but is frequently misdiagnosed as sinusitis, leading to inappropriate treatment with antibiotics and surgery. The objective of this study was to develop and validate a brief self-administered questionnaire, the Sinus Headache Screener (SHS), to help differentiate chronic rhinosinusitis (CRS) from non-rhinogenic facial pain or pressure (NRFP).

Patients presenting to the rhinology clinic with a chief complaint of facial pain or pressure completed an 89-item questionnaire bank developed previously through qualitative methods. A diagnosis of CRS or NRFP was given based on imaging criteria. Psychometric analysis and logistic regression were utilized to select items and create a scoring system that could reliably differentiate the two conditions. Predictive performance was evaluated through the area under the receiver operating characteristic curve (AUC) with bootstrapping.

Of 251 patients enrolled, 114 had CRS and 137 had NRFP. Mean (SD) age was 50 (16), and 69.3% were women. Eight items with scoring weights were included in the SHS. Scores ranged from -4 to 9, with higher positive values predictive of NRFP. With a score cutoff of > 0, the SHS had a sensitivity/specificity of 0.87/0.64, and positive/negative predictive values of 0.74/0.80 for NRFP. The optimism-corrected AUC was 0.798 (95% CI: 0.766, 0.877).

In patients presenting with sinus headache, the SHS accurately differentiated NRFP from CRS. The use of the SHS as a point-of-care clinical tool can improve diagnostic accuracy and facilitate cost-effective management.