The Pediatric Sinus Staging System: A Computed Tomography-Based Approach to Grading Pediatric Sinus Disease

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Radiology

Background:

• Pediatric chronic rhinosinusitis (CRS) lacks objective measures to predict surgical intervention needs.
• The adult Lund-Mackay (LM) score is used for computed tomography (CT) scans, but a pediatric-specific system is needed.
• The Pediatric Sinus Staging System (PSSS) was developed to address this gap, considering sinus opacification and development.

Purpose of the Study:

• To introduce and evaluate the Pediatric Sinus Staging System (PSSS) for pediatric CRS.
• To compare PSSS with the established Lund-Mackay (LM) score in pediatric patients.
• To assess the PSSS's ability to predict treatment outcomes, including the need for functional endoscopic sinus surgery (FESS).

Main Methods:

• Retrospective chart review of CT scans from pediatric CRS patients.
• Calculation of both LM and PSSS scores for each CT scan.
• Grouping patients based on treatment: medical therapy/adenoidectomy (med/adenoid), functional endoscopic sinus surgery (FESS), and revision FESS.

Main Results:

• 76 pediatric CRS patient scans were analyzed.
• PSSS scores were significantly lower in the control group compared to LM scores (P=.001).
• PSSS scores were significantly higher in patients with cystic fibrosis (P=.027) and CRS with polyps (P=.001).
• An ideal PSSS cutoff of ≥2 demonstrated 90.6% sensitivity and 50.0% specificity for distinguishing between med/adenoid and single FESS treatment.

Conclusions:

• The PSSS provides a more descriptive assessment of sinus disease by incorporating opacification and pneumatization.
• Current results suggest internal validity, with PSSS values showing similarity to LM scores.
• A PSSS score of ≥2 may assist clinicians in counseling families about the potential need for FESS.
• Further research is required for comprehensive validation of the PSSS.