Patient Factors Influence Minimal Clinically Important Difference for the SNOT-22 in Medically Treated Chronic Rhinosinusitis.

BACKGROUND

The present study explores the effect of sociodemographics and comorbidities on the calculated minimal clinically important difference (MCID) for 22-item Sinonasal Outcome Test (SNOT-22) scores in patients with medically treated chronic rhinosinusitis (CRS). The importance of delineating a threshold to indicate clinically meaningful changes perceived by a patient is well acknowledged, yet the influence of patient-specific factors on MCID has not been fully elucidated.

METHODS

Patients with CRS (n = 221) presenting to a tertiary care practice reported their change in disease burden with anchor questions following CRS-directed medical treatment. Baseline sociodemographics, pertinent history, and comorbid conditions, as well as pre- and post-treatment SNOT-22 scores were also collected. Adjusted logistic regression was utilized to determine the factors influencing MCID.

RESULTS

Among the 221 patients, 43.9% (n = 97) reported improvement following medical treatment. Gender, education level, depression, and migraine were identified as significant factors influencing perceived improvement. Our predictive model, incorporating these variables, achieved an area under the receiver operating characteristic curve of 0.818 (95% confidence interval [CI] = 0.762, 0.875), with a sensitivity of 74.4% and specificity of 77.9%. Changes in SNOT-22 scores were not strongly associated with perceived improvement in patients with depression (odds ratio [OR] = 1.06; 95% CI = 0.98, 1.14; p = 0.140). Conversely, patients with migraines perceived more pronounced improvements or deteriorations at the extremes of SNOT-22 score changes (OR = 0.84; 95% CI = 0.76, 0.93; p = 0.001).

CONCLUSION

Our findings underscore the substantial impact of patient-specific sociodemographics and comorbidities on the calculation of MCID values for the SNOT-22. This study advances our understanding of variability in MCID and demonstrates the complex milieu of factors affecting patients' perceived clinical outcomes.