What findings distinguish acute bacterial sinusitis?
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No combination of clinical findings can reliably distinguish acute viral rhinosinusitis from acute bacterial rhinosinusitis in primary care. Although unreliable, the best clinical predictor of acute bacterial sinusitis is the combination of unilateral nasal discharge and unilateral pain (positive likelihood ratio [LR+], 4.5; negative likelihood ratio [LR-], 0.25) (strength of recommendation [SOR]: B). History of purulent rhinorrhea (LR+, 1.5-1.9), maxillary tooth pain (LR+, 2.1-2.5), and purulent secretions in the nasal cavity (LR+, 2.1-5.5) may increase the likelihood of acute bacterial rhinosinusitis. Illness that starts as the common cold and pain on bending forward were not predictors of acute bacterial rhinosinusitis (SOR: B).
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