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Developing quality indicators to improve quality of care in ABRS1

Quality Indicators for the Diagnosis and Management of Acute Bacterial Rhinosinusitis1


Acute bacterial rhinosinusitis (ABRS), a complication of upper respiratory tract infections (URTIs), lacks specific quality indicators (Qls), which are recognised as an important initial step toward improving the quality of care provided to patients. Due to the large burden of illness, ABRS can benefit greatly from QI development. This current study aims to develop QIs for ABRS applicable to all relevant practitioners.


  • Following a literature review, 4 guidelines and 1 consensus statement were selected and independently reviewed by 3 authors to extract candidate indicators (CIs).

These included:

  • The Canadian Clinical Practice Guidelines
  • The American Academy of Otolaryngology — Head and Neck Surgery Clinical Practice Guidelines
  • The European Position Paper on Rhinosinusitis and Nasal Polyps
  • The Infectious Disease Society of America Clinical Practice Guidelines
  • Recommendations from the Rhinosinusitis International Consensus Statement on Allergy and Rhinology.
  • An expert panel was formed of 9 otolaryngology — head and neck surgeons with both academic and community experience, and demonstrated research interest in patient safety, quality improvement, clinical experience, and ABRS management.
  • Final QIs were selected from the CIs utilising the modified RAND/University of California at Los Angeles appropriateness methodology, with 2 rounds of anonymous, independent ratings by panel members for each CI, and an intervening meeting/teleconference.

Key outcomes: 7 Quality Indicators for ABRS

This study proposes 7 ABRS-specific QIs to evaluate diagnosis and management that reduces symptoms, improves quality of life, and prevents complications:

  1. Accurate clinical diagnosis of ABRS is made using signs and symptoms
  2. Nasal culture is not required for diagnosis of ABRS
  3. Uncomplicated ABRS does not require radiographic imaging
  4. Antibiotics may be prescribed for ABRS if disease severely impacts quality of life (QOL)/productivity, the condition worsens, the patient is unable to follow-up, and/or the patient’s condition fails to improve by 7 days after ABRS diagnosis
  5. CT scan should be obtained for patients with recurrent ABRS
  6. Amoxicillin for 5–10 days should be used as first-line antibiotic therapy for ABRS
  7. Adjunct therapy should be prescribed in individuals with ABRS.


  • The proposed QIs measure high-yield aspects of ABRS care, including accurate diagnosis, prudent investigations, and evidence-based therapies.
  • Striving to improve performance on these strategically selected indicators of quality care in ABRS would serve to improve the effectiveness and efficiency of individual practices, and the healthcare system as a whole, to better serve patients.



  1. Cottrell J, Yip J, Chan Y, et al. Quality Indicators for the Diagnosis and Management of Acute Bacterial Rhinosinusitis. Am J Rhinol Allergy 2020;34(4):519–531.

    Article originally published March, 2020

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