Evaluation of the Patient Global Impression of Symptom Severity (PGISS) Score as a Subjective and Objective Measure of Disease Activity in Chronic Rhinosinusitis

Background: The Sino-nasal Outcome Test (SNOT-22) is a 22-question survey that is utilized to evaluate health-related quality of life of patients with chronic rhinosinusitis (CRS). The Patient Global Impression Symptom Severity (PGISS) is a similar yet versatile instrument that combines features of both a Likert scale and a visual analog to assess symptom severity in CRS patients. While previous studies have evaluated the validity of SNOT-22 as an instrument to measure CRS patients' symptom severity, no studies have evaluated PGISS scale's ability to evaluate and guide treatment plans for CRS patients.

Objective: The primary objective of this study was to analyze the clinical utility of PGISS in assessing subjective symptom severity and objective disease status in CRS patients. We additionally aimed to investigate if PGISS scores could serve as predictors for treatment strategies in CRS patients.

Methods: Electronic medical records of CRS patients were retrospectively reviewed between January 2020 and January 2021 from Eastern Virginia Medical School and Sentara Healthcare. Information on demographics, objective disease metrics, treatment, and labs were collected. Statistical analyses were conducted using SAS 9.4 software.

Results: A total of 150 patients were included in our study. A statistically significant positive correlation was found between PGISS and SNOT-22 scores (r(131) = 0.701, P < .0001). Patients with moderate to severe PGISS scores had significantly higher odds of changing their treatment course (odds ratio [OR] = 6.813, P = .001, and OR = 5.491, P = .018, respectively). Additionally, patients with severe PGISS scores had decreased odds of receiving biological intervention (OR = 0.048, P = .043), but they had considerably higher odds of pursuing surgery (OR = 15.939, P = .046). No significant associations were seen between PGISS scores and receiving topical steroids, systematic steroids, nonsteroidal medical treatment, or imaging interventions (P > .05).

Conclusion: Clinicians may consider using the PGISS scale as an alternative method to the SNOT-22 to evaluate subjective symptom severity and guide treatment plans for patients with CRS.