Table 4

Indicators of the severity of an upper ARinf in athletes (history, physical examination and results of special investigations)

IndicatorSpecific parameterSeverity
MildModerateSevere/complicated
Symptoms

  • Predominant location of symptom/s*

  • Predominantly upper respiratory symptoms without regional or systemic symptoms

  • Predominantly upper or lower respiratory

OR

  • Regional symptoms (head, neck, chest) without systemic symptoms

  • Multiple symptoms (upper or lower respiratory) with systemic symptoms

AND/OR

  • Other symptoms that may indicate multiorgan (non-respiratory) involvement

  • Type of symptom/s*

  • Blocked/plugged nose, runny nose, sneezing, altered/loss sense of smell or taste, sinus pressure, sore/scratchy throat, hoarseness

  • Lower respiratory tract symptoms (dry or wet/productive cough, difficulty in breathing†, fast breathing or shortness of breath†, chest pain associated with breathing or coughing)

  • Other regional symptoms (headache and red, watery or scratchy eyes)

  • Systemic symptoms (fever, chills, excessive fatigue, general muscle aches and pains, skin rash)

  • Symptoms indicating other organ involvement for example, cardiac (chest pain, pressure or tightness, dizziness, palpitations/racing heart, shortness of breath†), gastrointestinal (severe abdominal pain, nausea, vomiting, diarrhoea and loss of appetite) or other organ systems

  • Symptom severity (European Position Paper on Rhinosinusitis and Nasal Polyps - EPOS 2020 statement) (VAS score 0–10) ‡

0–3>3–7>7–10

  • Symptom duration (time course over days from onset of symptoms)

  • Short duration with early resolution (<3 days)

  • More prolonged resolution of symptoms (3–7 days)

  • Complicated with symptoms >7 day or symptoms that initially improve and then recur or become more severe

  • Total no of symptoms

<55–9 >10
Clinical signs

  • Respiratory system (evidence of complications)

  • Predominantly upper/localised ARinf with no complications

  • Upper/lower respiratory ARinf with some regional involvement/complications (ears, lymphadenopathy, trachea, bronchial)

  • ARinf complicated by involvement of the lung parenchyma (pneumonia)

  • Symptoms and clinical signs of systemic illness§

  • None

  • Few, mild, transient (lasting <48 hours) signs of systemic illness

  • Typical of non-specific acute phase reaction to infections

  • Multiple and prolonged (lasting >48 hours) signs of systemic illness

  • Multiorgan involvement

  • No clinical evidence of suspected or confirmed multiorgan (non-respiratory) involvement

  • No clinical evidence of suspected or confirmed multiorgan (non-respiratory) involvement

Clinical evidence of suspected multiorgan (non-respiratory) involvement¶

  • Clinical evidence of confirmed multiorgan (non-respiratory) involvement

Laboratory tests for non-specific systemic involvement

  • Inflammatory makers (CRP)

  • Normal

  • Normal or transient, mild elevation early in the disease

  • Prolonged or significant increase

Pathogen identification (if indicated)

  • Nasopharyngeal PCR

  • Throat swab and culture

  • Rapid antigen test

  • Serum antibody tests (rise in antibodies)

  • Generally, pathogen identification not indicated.

  • Identification may be useful to control viral outbreaks.

  • Pathogen identification may be indicated to enhance the quality of care and differentiate between viral and bacterial infections.

  • Pathogen identification is recommended to enhance the quality of care and differentiate between viral and bacterial infections

Special investigations to exclude multiorgan involvement

  • Types of investigations determined by clinical suspicion of organ system/s involved

  • Generally special investigations are not indicated

  • Normal if results are available

  • Special investigations not routinely done – only indicated if clinical suspicion

  • Normal or mild transient abnormality

  • Special investigations are indicated to confirm multiorgan complication

  • *Refer to online supplemental table S2: Symptoms of ARinf.

  • †Symptoms that can indicate lower respiratory tract involvement and/or cardiac involvement.

  • ‡VAS 0–10 (not troublesome to worst thinkable troublesome) (VAS >5 affects quality of life) from EPOS 2020 statement25

  • §Confirmed fever (core temperature >38°C), resting tachycardia, myalgia/arthralgia, headache, malaise/excessive fatigue.

  • ¶Special investigations to exclude multiorgan involvement are recommended (see online supplemental table S4).

  • ARinf, acute respiratory infections; CRP, C reactive protein; VAS, Visual Analogue Scale.