Literature Review: A Roundup of Important Recent Studies

Study design: Systematic literature review for level of evidence about diagnosis and treatment of “sinus headache.”

Setting: Multi-institutional review panel; academic medical centers.

Synopsis: Rhinosinusitis Task Force criteria of diagnosis of chronic sinusitis were reviewed. The International Headache Society criteria for headache attributed to rhinosinusitis and for migraine headache were reviewed, along with supporting literature. Evidence-based studies of level B and higher were reviewed for the diagnosis of sinus headache and for migraine headache. Based on these reviews, a summary of the diagnosis and treatment of “sinus headache” versus migraines was established.

Bottom line: “Sinus headache” requires an adequate workup to determine the true etiology of the headache. Treatment will follow in a more precise and targeted fashion. The workup should include history, physical exam, neurological exam, nasal endoscopy and CT scan with high suspicion for a diagnosis of migraine headache. Findings of sinusitis on CT scan or endoscopy with appropriate history will focus more on a rhinologic cause.

Reference: Patel ZM, Kennedy DW, Setzen M, Poetker DM, DelGaudio JM. “Sinus headache”: rhinogenic headache or migraine? An evidence-based guide to diagnosis and treatment. Int Forum Allergy Rhinol. 2013;3:221-230.

—Reviewed by James A. Stankiewicz, MD

Hospital-Acquired Conditions after HN Cancer Surgery Uncommon but Costly

How rare are hospital-acquired conditions (HACs) after head and neck cancer (HNCA) surgery, and how do they relate to mortality, complications and costs?

Background: In 1999, the Institute of Medicine (IOM) reported that medical errors were a leading cause of death and disability. Only a small number of HACs represent true medical errors. The authors note that there have been no studies that address the incidence of HACs in HNCA surgical patients. This study was set to determine the incidence of HACs in HNCA surgery and its association with in-hospital mortality, complications, hospitalization length and costs.

Study design: Retrospective cross-sectional study of discharge data for 123,662 adult patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal or oropharyngeal neoplasm during 2001–2008.

Setting: Discharge data from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.

Synopsis: HACs were uncommon (<1 percent of all cases), and the majority experienced only one. Vascular catheter-associated infection was the most common, followed by falls and trauma, central line-associated bloodstream infection and foreign objects retained after surgery. Individual analysis revealed vascular catheter-associated infection was associated with major surgical procedures, flap reconstruction and a comorbidity score ≥ 2; central line-associated bloodstream infection was associated with urgent/emergency admission, flap reconstruction and a comorbidity score ≥ 2. Patients with HACs were significantly more likely to be admitted through urgent or emergency care, have advanced comorbidity, undergo major surgical procedures, have pedicled or free flap reconstruction, suffer an acute post-operative complication and die in hospital. Flap reconstruction was more common in patients who developed HACs (30.5 percent) than in those who did not (9.1 percent). There were no significant differences between hospital characteristics and HAC incidence. Study limitations included not being able to derive a meaningful analysis of long-term outcomes; a lack of data on readmission, previous surgical procedures or prior chemotherapy; a limited ability to adequately control for case mix; and a possible under-reporting of complications.