Technical Report: Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Overview

Ioannidis, John P. A.; Lau, Joseph

doi:10.1542/peds.108.3.e57

Cited by 53 publications

(25 citation statements)

References 29 publications

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“…Previous systematic reviews have been limited by focusing only on children, 10,11 have not identified all relevant studies, 11 or are ≥10 years old. 10,12 The goal of the current study is to perform an updated, comprehensive systematic review of the accuracy of imaging and laboratory tests for the diagnosis of ARS and ABRS.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy

et al. 2016

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BackgroundAcute rhinosinusitis (ARS) is a common primary care infection, but there have been no recent, comprehensive diagnostic meta-analyses. AimTo determine the accuracy of laboratory and imaging studies for the diagnosis of ARS. Design and settingSystematic review of diagnostic tests in outpatient, primary care, and specialty settings. MethodThe authors included studies of patients presenting with or referred for suspected ARS, and used bivariate meta-analysis to calculate summary estimates of test accuracy and the area under the receiver operating characteristic (ROC) curve. The authors also plotted summary ROC curves to explore heterogeneity, cutoffs, and the impact of different reference standards. ResultsUsing antral puncture as the reference standard, A mode ultrasound (positive likelihood ratio [LR+] 1.71, negative likelihood ratio [LR-] 0.41), B mode ultrasound (LR+ 1.64, LR-0.69), and radiography (LR+ 2.01, LR-0.28) had only modest accuracy. Accuracy was higher using imaging as the reference standard for both ultrasound (LR+ 12.4, LR-0.35) and radiography (LR+ 9.4, LR-0.27), although this likely overestimates accuracy. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) both had clear threshold effects, and modest overall accuracy. The LR+ for ESR >30 and >40 were 4.08 and 7.40, respectively. A dipstick of nasal secretions for leucocyte esterase was highly accurate (LR+ 18.4, LR-0.17) but has not been validated. ConclusionIn general, tests were of limited value in the diagnosis of ARS. Normal radiography helps rule out sinusitis when negative, whereas CRP and ESR help rule in sinusitis when positive, although, given their limited accuracy as individual tests, they cannot be routinely recommended. Prospective studies integrating signs and symptoms with point-of-care CRP, dipstick, and/ or handheld B-mode ultrasound are needed.

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Section: Introductionmentioning

confidence: 99%

“…10,12 The goal of the current study is to perform an updated, comprehensive systematic review of the accuracy of imaging and laboratory tests for the diagnosis of ARS and ABRS.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy

et al. 2016

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“…1 In adults, Gwaltney et al 2 showed extensive radiologic changes in the nasal passages, ostiomeatal area, and sinus cavities during viral colds. It has been assumed that children have similar changes.…”

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confidence: 99%

Paranasal Sinus Findings in Children During Respiratory Infection Evaluated With Magnetic Resonance Imaging

Kristo¹,

Uhari

Luotonen³

et al. 2003

Pediatrics

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ABSTRACT. Objective. The spreading of acute respiratory infection into the paranasal sinuses in children is poorly defined. The main objective of this study was to evaluate the frequency and spontaneous resolution of paranasal sinus abnormalities in children with acute respiratory infection using magnetic resonance imaging (MRI).Methods. We examined 60 children with MRI (mean age: 5.7 years) with symptoms of acute respiratory infection. Twenty-six children with major abnormalities in the first MRI scan had a follow-up MRI taken 2 weeks later.Results. The children had had symptoms of uncomplicated acute respiratory infection for an average of 6 days before the first examination (mean duration: 6. Conclusions. These observations indicate that acute respiratory infection mostly spreads into the paranasal sinuses of children in the form of mucosal edema and that these abnormalities tend to resolve spontaneously without antimicrobial treatment. Pediatrics 2003;111:e586 -e589. URL: http://www.pediatrics.org/cgi/content/full/111/5/e586; sinusitis, children, acute respiratory infection, MRI.

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“…Entre os pacientes com SAB, a disponibilidade de informação baseada em evidência é menor do que para as situações anteriormente comentadas 59 . Em 2001, a AAP publicou recomendações para o manejo de pacientes com quadro clínico sugestivo de SAB com base em um consenso entre especialistas, de forma a complementar as questões para as quais as evidências eram insuficientes 60 (Figura 4).…”

Section: Uso De Antibióticos Em Infecções De Vias Aéreasunclassified

Outpatient antibiotic therapy as a predisposing factor for bacterial resistance: a rational approach to airway infections

Nascimento‐Carvalho¹

2006

J Pediatr (Rio J)

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Objectives: To present evidence-based recommendations for the use of antibiotics for the treatment of the most common acute respiratory infections (ARI) and the available information on the importance of this type of management.Sources: MEDLINE and LILACS databases, technical publications by international organizations, national and international directives. The search terms acute respiratory infection, otitis, sinusitis, tonsillitis, pneumonia, antibiotic, guidelines and bacterial resistance were used. Articles cited by the articles selected were analyzed for information of interest.Summary of the findings: Bacterial resistance has grown, to the extent that today it is recognized as a global public health problem. ARI are the most common cause of antibiotic usage within the community; yet a large proportion of these cases, compromising the upper (otitis, sinusitis, tonsillitis) or the lower airways (pneumonia), are the result of viral infections. Recommendations to rationalize the use of antibiotics in patients with ARI have the common objective of minimizing unnecessary antibiotic use, since antibiotic pressure is one of the factors triggering bacterial resistance.Conclusions: It is of great importance to differentiate among ARI patients those who will benefit from the use of antibiotics. The establishment of recommendations for the prescription of antibiotics is one strategy for minimizing the frequency of bacterial resistance.J Pediatr (Rio J). 2006;82(5 Suppl):S146-52: Antibiotics, bacterial resistance, otitis, sinusitis, tonsillitis, pneumonia. ResumoObjetivos: Apresentar as recomendações baseadas em evidência para uso de antibióticos no tratamento das infecções respiratórias agudas (IRA) mais freqüentes e as informações disponíveis sobre a importância desse tipo de conduta.Fontes dos dados: Bases de dados MEDLINE, LILACS, publicações técnicas de organizações internacionais, diretrizes nacionais e internacionais. Foram utilizados os unitermos acute respiratory infection, otitis, sinusitis, tonsillitis, pneumonia, antibiotic, guidelines, bacterial resistance. Artigos citados pelos artigos incluídos foram analisados quanto à apresentação de informação de interesse. Síntese dos dados:A resistência bacteriana tem crescido, sendo atualmente reconhecida como problema mundial de saúde pública. As IRA são a causa mais freqüente para uso de antibiótico na comunidade; grande parte desses casos, tanto nas vias aéreas superiores (otite, sinusite, faringoamidalite) como nas inferiores (pneumonia), são decorrente de infecção viral. As recomendações para racionalizar o uso de antibióticos nos pacientes com IRA têm como objetivo comum minimizar o uso desnecessário de antibióticos, visto que a pressão antibióti-ca é um dos fatores desencadeantes da resistência bacteriana.Conclusões: É de grande importância a distinção, entre os pacientes com IRA, daqueles que podem se beneficiar do uso de antibióticos. O uso das recomendações para a prescrição de antibióticos é uma estratégia para minimizar a freqüência de resistên...

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Technical Report: Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Overview

Cited by 53 publications

References 29 publications

Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy

Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy

Paranasal Sinus Findings in Children During Respiratory Infection Evaluated With Magnetic Resonance Imaging

Outpatient antibiotic therapy as a predisposing factor for bacterial resistance: a rational approach to airway infections

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