Value of routine sinus radiography in the diagnostic work-up of ill returned travelers: critical appraisal in a cohort of 765 travelers

BACKGROUND Upper respiratory tract problems, eg, acute sinusitis are frequently occurring illnesses in returned travelers. The most accurate and cost-effective method for diagnosing these upper respiratory tract illnesses in hospital-based settings remains an area of uncertainty. In the present retrospective cohort study, the usefulness of routine sinus radiography in the diagnostic work-up of ill returned travelers was evaluated. METHODS This study was done at the Institute for Tropical Diseases in Rotterdam, and included all returned travelers who were ill with symptoms lasting less than one month in the period 2007-2009 and had sinus radiography on admission. Traveler demographic (including travel history), clinical, and laboratory data were collected on admission, and sinus radiography findings evaluated for their diagnostic power to predict sinusitis. RESULTS One hundred and sixty-five (22%) of 765 ill returned travelers had abnormal sinus radiography; more than half of the abnormal radiographic findings comprised mucosal membrane thickening of the sinuses. More than half of the travelers with abnormal sinus radiography had no upper respiratory tract symptoms at admission, which raises doubt about the clinical relevance of abnormal radiographic findings. Travelers with abnormal sinus radiography were more likely to receive nasal decongestants (relative risk 18.2, confidence interval 9.4-35.1) but not antibiotics. CONCLUSION The results of the present study indicate that there is no additional value for routine sinus radiography in the diagnostic work-up of ill returned travelers.