Aggregate evidence quality: C; observational studies
BenefitsIdentification of patients who may have been misdiagnosed, those at risk of complications, and those who require a change in management.
HarmDelay of up to 72 hours in changing therapy if patient fails to improve.
CostAdditional provider and caregiver time and resources.
Benefits-harm assessmentPreponderance of benefit.
Value judgmentsUse of 72 hours to assess progress may result in excessive classification as treatment failures if premature; emphasis on importance of worsening illness in defining treatment failures.
Role of patient preferencesCaregivers determine whether the severity of the patient's illness justifies the report to clinician of the patient's worsening or failure to improve.
Intentional vaguenessNone.
ExclusionsPatients with severe illness, poor general health, complicated sinusitis, immune deficiency, previous sinus surgery, or coexisting bacterial illness.
StrengthRecommendation.