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Acute Sinusitis in Children, Supplement

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Full Title: Diagnosis and Treatment of Uncomplicated Acute Sinusitis in Children, Supplement

October 2000

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Structured Abstract

Objectives: This report evaluates and analyzes the existing evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children.

Search Strategy: Human studies of sinusitis were identified using MEDLINE® (from 1966 to March 1999), technical experts, and bibliographies.

Selection Criteria: A systematic review and meta-analysis considered all pertinent studies that included at least 10 children younger than 18 years of age with symptoms of uncomplicated acute bacterial rhinosinusitis of less than 30 days duration. Only diagnostic studies that compared two or more tests were used. Both randomized and nonrandomized controlled trials were included to assess treatment efficacy.

Analysis: The analysis focused on clinical improvement rates for intervention studies of antibiotics or ancillary measures and the concordance of diagnostic tests, expressed as likelihood ratios.

Main Results: Of 1,857 citations reviewed, the authors identified 21 qualifying studies, compared with 450 reports on complications of acute sinusitis and 233 nonsystematic reviews of the subject, which did not qualify for inclusion. The qualifying studies included five randomized trials and eight case series on antibiotic therapy, three randomized trials on ancillary treatments, and eight studies with information on diagnostic tests (including three of the therapeutic trials). Definitions and inclusion criteria were heterogeneous across studies. The pooled clinical improvement rate with antibiotics was 87.6 percent (177/202) in randomized trials and 92.2 percent (318/345) in nonrandomized studies (p = 0.08). The respective improvement rates without antibiotics were 60 percent and 80 percent. Improvement rates were significantly higher in nonrandomized studies. Data on ancillary measures were sparse and heterogeneous.

In studies with both clinical and plain film radiography, the pooled rate of abnormal radiographic findings against a clinical diagnosis of sinusitis was 73.2 percent (596/814; range 55.4 percent to 96 percent among studies).

There was poor concordance between clinical criteria, plain film radiography, ultrasonography, computed tomography, and fluid on aspiration in all available paired assessments.

Conclusions: High-quality evidence for acute uncomplicated sinusitis in children is very limited. Diagnostic modalities show poor concordance, and treatment options are based on inadequate data. More evidence is needed for this very common condition.

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Diagnosis and Treatment of Uncomplicated Acute Sinusitis in Children, Supplement

Evidence-based Practice Center: New England Medical Center
Topic Nominators: American Academy of Otolaryngology, American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians

Current as of October 2000


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