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Diagnosis and management of acute sinusitis by pediatricians
Lon McQuillan1, Lori A Crane, Allison Kempe
1Departments of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA. lmcquillan@samhealth.org
Insights
Pediatrician practices for diagnosing and managing acute sinusitis in young children vary significantly. Most rely on symptom duration, with common antibiotic use and occasional imaging, practices needing reevaluation.
Area of Science:
- Pediatric Medicine
- Infectious Diseases
- Diagnostic Practices
Background:
- Acute sinusitis is a common diagnosis in young children.
- Pediatrician approaches to diagnosis and management are not well-understood.
Purpose of the Study:
- To describe pediatrician diagnostic and management strategies for nonsevere acute sinusitis in children up to 6 years old.
Main Methods:
- A national random sample of 750 general pediatricians surveyed via mail.
- Data collected on diagnostic criteria, imaging use, and treatment modalities.
Main Results:
- Significant variation exists in the age pediatricians consider acute sinusitis.
- Prolonged symptom duration is the primary diagnostic factor (93%).
- Antibiotics are frequently used (96%), with common use of contingency prescriptions (53%) and occasional sinus CT scans (58%).
Conclusions:
- Wide variation in diagnostic age and reliance on symptom duration noted.
- Occasional use of sinus CT scans in young children is prevalent despite limitations.
- Common antibiotic use, contingency prescriptions, and adjuvant therapies warrant further investigation and reevaluation.
Background:
Acute sinusitis is frequently diagnosed in young children, yet little is known regarding pediatrician practices surrounding its diagnosis and management.
Objectives:
The purpose of this work was to describe how pediatricians diagnose and manage nonsevere acute sinusitis in otherwise healthy children < or =6 years of age.
Methods:
We used a mail survey administered from June to August 2007 to a national random sample of 750 general pediatricians from the American Medical Association Master File. RESULTS. The response rate was 45% (N = 271). Pediatricians reported first considering acute sinusitis at the ages of 0 to 5 (6%), 6 to 11 (17%), 12 to 23 (36%), 24 to 35 (21%), and > or =36 (20%) months. Symptoms thought to be "very important" in the diagnosis of acute sinusitis included prolonged symptom duration (93%), purulent rhinorrhea (55%), and nasal congestion (43%); 60% reported that symptom duration is more important than symptom combination. Symptom durations expected before considering the diagnosis were 1 to 6 (3%), 7 to 9 (17%), 10 to 13 (37%), 14 to 16 (38%), and > or =17 (6%) days. Fifty-eight percent reported using sinus computed tomography scans "occasionally" or more often in the diagnosis of acute sinusitis. Ninety-six percent reported treating acute sinusitis with an antibiotic "frequently" or "always." Fifty-three percent reported using contingency antibiotic prescriptions "occasionally" or more often for acute sinusitis. Adjuvants used "frequently" or "always" included saline washes (44%), systemic decongestants (28%), nasal corticosteroids (20%), and systemic antihistamines (13%).
Conclusions:
We found significant variation in the age at which pediatricians begin considering the diagnosis of nonsevere acute sinusitis in children. Most pediatricians consider symptom duration the most important diagnostic factor. The majority of pediatricians use sinus computed tomography imaging at least occasionally in young children with nonsevere symptoms despite its limitations in this clinical setting. Although poorly understood, the use of contingency antibiotic prescriptions is common. Lastly, the use of systemic decongestants and antihistamines in young children is reported, a practice that needs to be reexamined in light of recent Food and Drug Administration warnings regarding their safety.
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