Acute Maxillary Sinusitis in Children

Wald, Ellen R.; Milmoe, Gregory; Bowen, AʼDelbert; Ledesma-Medina, Jocyline; Salamon, Nan; Bluestone, Charles D.

doi:10.1056/nejm198103263041302

Cited by 435 publications

(198 citation statements)

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“…Transillumination of the sinuses is difficult to perform correctly in children and has been shown to be unreliable. 15,16 Nasopharyngeal cultures do not reliably predict the etiology of acute bacterial sinusitis. 14,16 Only a minority (∼6%-7%) of children presenting with symptoms of URI will meet criteria for persistence.…”

Section: Optionmentioning

confidence: 99%

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Wald,

Applegate,

Bordley

et al. 2013

Pediatrics

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446

368

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OBJECTIVE: To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. METHODS: Analysis of the medical literature published since the last version of the guideline (2001). RESULTS: The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever [temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the first-line treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening (progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management. If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially managed with observation. CONCLUSIONS: Changes in this revision include the addition of a clinical presentation designated as “worsening course,” an option to treat immediately or observe children with persistent symptoms for 3 days before treating, and a review of evidence indicating that imaging is not necessary in children with uncomplicated acute bacterial sinusitis.

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Section: Optionmentioning

confidence: 99%

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Wald,

Applegate,

Bordley

et al. 2013

Pediatrics

Self Cite

446

368

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“…Therefore, sinus radiographs and a previously developed classification scheme were used as the criterion standard. This scheme has been shown to correlate well with maxillary sinus aspiration (3,14). Furthermore, sinus radiographs are readily obtained by the primary care physician and can be considered to be a pragmatic standard.…”

Section: Discussionmentioning

confidence: 93%

“…All children for whom a sinus radiograph was ordered were included. The radiologists were blind to clinical data and used explicit criteria for diagnosing sinusitis (3)(4)12). Also, the patients had a broad spectrum of symptoms and were drawn from speciality clinics (ear nose and throat) and general clinics (paediatric, emergency room).…”

Section: Discussionmentioning

confidence: 99%

“…Also, the patients had a broad spectrum of symptoms and were drawn from speciality clinics (ear nose and throat) and general clinics (paediatric, emergency room). The authors' selection criteria avoided the bias of other paediatric studies in which the criterion standard was applied only to patients with a high probability of disease (3,13).…”

Section: Discussionmentioning

confidence: 99%

“…The presence of an air-fluid level within the maxillary sinus or maxillary opacification in a patient with sinusitis symptoms correlates with the recovery of pathogenic bacteria from maxillary sinus aspiration in more than 70% of children (3).…”

Section: Les Symptômes Et La Probabilité Clinique Initiale Prédisent-mentioning

confidence: 99%

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Do symptoms and initial clinical probability predict the radiological diagnosis of acute sinusitis in children?

Cyr¹,

Racette²,

Leduc³

et al. 2001

Paediatrics &Amp; Child Health

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OBJECTIVE:To evaluate the value of signs and symptoms in children for the radiological diagnosis of acute sinusitis. DESIGN: Prospective cohort study. SETTING: University-affiliated tertiary care hospital. PATIENTS: All children presenting with symptoms suggestive of acute sinusitis for whom sinus radiographs were ordered. METHODS: Data were collected on the presence of specific symptoms and the initial probability of sinusitis. Criterion-based radiological diagnoses were made. RESULTS: Three hundred ninety-two consecutive children were seen; 257 children had a radiological diagnosis of acute sinusitis (66%), 128 patients (33%) presented with complete opacity of at least one sinus and 14 (4%) children had an air-fluid level. Sensitivity, specificity, predictive values and likelihood ratios were measured for clinical findings. Classical symptoms (rhinorrhea lasting more than 10 days and purulent rhinorrhea) increased the likelihood ratios the most (1.3 and 1.34, respectively). Logistic regression showed two independent predictors: purulent rhinorrhea (odds ratio 2.0) and the presence of acute otitis media (odds ratio 2.6). The initial clinical probability was more accurate than any other single finding: high probability (likelihood ratio 2.0), intermediate probability (likelihood ratio 1.1) and low probability (likelihood ratio 0.6). CONCLUSION: Classical symptoms are predictive of the presence of acute sinusitis as diagnosed on sinus radiographs. The physician's overall clinical impression, expressed as an initial probability, was superior to any single historical or examination finding in the diagnosis of acute sinusitis. Key Words: Diagnosis; SinusitisLes symptômes et la probabilité clinique initiale prédisent-ils le diagnostic radiologique de sinusite aiguë chez l'enfant? OBJECTIF : Évaluer la valeur des signes et symptômes chez les enfants pour ce qui est du diagnostic radiologique de sinusite aiguë MÉTHODOLOGIE : Étude prospective de cohorte LIEU : Hôpital universitaire de soins tertiaires PATIENTS : Tous les enfants présentant des symptômes laissant présumer la présence d'une sinusite aiguë qu'on a envoyés passer une radiographie des sinus MÉTHODES : Les données ont été colligées en présence de symptômes précis et de la probabilité initiale de sinusite. Des diagnostics radiologiques ont été posés selon des critères établis. RÉSULTATS : Trois cent quatre-vingt-douze enfants consécutifs ont été vus, dont 257 avaient reçu un diagnostic radiologique de sinusite aiguë (66 %), 128 (33 %) présentaient une opacité complète d'au moins un sinus et 14 (4 %), un niveau hydroaérique. La sensibilité, la spécificité, les valeurs prédictives et les rapports des vraisemblances ont été mesurés pour ce qui est des observations cliniques. Les symptômes classiques (rhinorrhée de plus de 10 jours et rhinorrhée purulente) étaient responsables de la hausse la plus marquée des rapports des vraisemblances (1,3 et 1,34, respectivement). La régression logistique a révélé deux prédicteurs indépendants : une rhinorrhée purulente (ratio...

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Branhamella catarrhalis as a Lower Respiratory Tract Pathogen in Patients With Chronic Lung Disease

et al. 1986

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Acute Maxillary Sinusitis in Children

Cited by 435 publications

References 12 publications

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Do symptoms and initial clinical probability predict the radiological diagnosis of acute sinusitis in children?

Branhamella catarrhalis as a Lower Respiratory Tract Pathogen in Patients With Chronic Lung Disease

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