Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control
Bibliographic record
Abstract
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 (κw = 0.758). Rhinologist‐assessed CRS control agreed with patient‐reported CRS control significantly better when rhinologists had knowledge of patient‐reported CRS control (κw = 0.736 vs. κw = 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 (κw = 0.529) and without (κw = 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".