Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. e193-e198 (doi:10.1542/peds.2008-2479)
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ARTICLE

Diagnosis and Management of Acute Sinusitis by Pediatricians

Lon McQuillan, MD, MSPHa,b, Lori A. Crane, PhD, MPHc,d and Allison Kempe, MD, MPHa,b,d

a Departments of Pediatrics
c Preventive Medicine and Biometrics
d Colorado Health Outcomes Program, University of Colorado Denver, Aurora, Colorado
b Children's Outcomes Research Program, Children's Hospital, Aurora, Colorado

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 ≤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 ≥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 ≥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.

Key Words: sinusitis • antibiotic use

Abbreviations: AAP—American Academy of Pediatrics • CT—computed tomography • AMA—American Medical Association • HMO—health maintenance organization • MCO—managed care organization • CHC—community health center • OR—odds ratio • CI—confidence interval • FDA—Food and Drug Administration

Accepted Oct 10, 2008.


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