Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control

Ahmad R Sedaghat; David S Caradonna; Rakesh K Chandra; Christine Franzese; Stacey T Gray; Ashleigh A Halderman; Claire Hopkins; Edward C Kuan; Jivianne T Lee; Edward D McCoul; Erin K O'Brien; Steven D Pletcher; Melissa A Pynnonen; Eric W Wang; Sarah K Wise; Bradford A Woodworth; William C Yao; Katie M Phillips

doi:10.1002/alr.23168

Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control

Int Forum Allergy Rhinol. 2023 Nov;13(11):2004-2017. doi: 10.1002/alr.23168. Epub 2023 May 12.

Authors

Ahmad R Sedaghat¹, David S Caradonna², Rakesh K Chandra³, Christine Franzese⁴, Stacey T Gray⁵, Ashleigh A Halderman⁶, Claire Hopkins⁷, Edward C Kuan⁸, Jivianne T Lee⁹, Edward D McCoul¹⁰, Erin K O'Brien¹¹, Steven D Pletcher¹², Melissa A Pynnonen¹³, Eric W Wang¹⁴, Sarah K Wise¹⁵, Bradford A Woodworth¹⁶, William C Yao¹⁷, Katie M Phillips¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
² Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁷ Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA.
⁹ Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA.
¹⁰ Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.
¹⁶ Department of Otolaryngology, University of Alabama, Birmingham, Alabama, USA.
¹⁷ Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.

PMID: 37042828
DOI: 10.1002/alr.23168

Abstract

Background: We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient-reported CRS control).

Methods: Fifteen rhinologists were provided with real-world data from 200 CRS patients. Participating rhinologists first classified patients' CRS control as "controlled," "partly controlled," and "uncontrolled" using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient-reported CRS control. They then classified patients' CRS control without knowledge of patient-reported CRS control. Interrater reliability and agreement of rhinologist-assessed CRS control with patient-reported CRS control and EPOS guidelines were determined.

Results: CRS control classification with and without knowledge of patient-reported CRS control was highly consistent across rhinologists (κ_w = 0.758). Rhinologist-assessed CRS control agreed with patient-reported CRS control significantly better when rhinologists had knowledge of patient-reported CRS control (κ_w = 0.736 vs. κ_w = 0.554, p < 0.001). Patient-reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists' assessment of CRS control. Rhinologists' CRS control assessments weakly agreed with EPOS CRS control guidelines with (κ_w = 0.529) and without (κ_w = 0.538) patient-reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases.

Conclusions: This study directly demonstrates the importance of patient-reported CRS control as a dominant influence on rhinologists' CRS control assessment. Knowledge of patient-reported CRS control may better align rhinologists' CRS control assessments and treatment decisions with patients' perspectives.

Keywords: EPOS; chronic rhinosinusitis; disease control; outcome measure; patient-reported; rhinologist.