September 2019 HSC Section 1 Congenital and Pediatric Problems

Beswick et al

Table 2.  Comparison of Selected Data From ARS and ASPO Respondents for Managing Pediatric Chronic Rhinosinusitis. ARS ASPO % Responses No. Responses % Responses No. Responses

P Value

Practice type and training Academic practice  Completed fellowship

38.8 40.3

26 27

62.6 95.6

72

.007

109

<.001

Use of endoscopy for diagnosis Always/almost always

47.5 21.3 26.2

29 13 16

25.0 26.8 36.6 11.6

28 30 41 13

.021

 Usually

 Sometimes  Rarely/never

4.9

3

Initial medical management  Oral steroids Maximal medical management  Oral steroids Duration of oral antibiotic use Less than 14 days

19.7

12

7.8

9

.025

72.1

44

42.6

49

.001

26.7 56.7 16.7

16 34 10

11.5 64.6 23.9

13 73 27

.023

15-21 days

Greater than 21 days Initial surgical treatment  Adenoidectomy alone

43.0

25

69.6

80

.001

Most commonly perform adenoidectomy Prior to obtaining CT scan

53.3 36.7 10.0 27.1 28.8 44.1

32 22

81.6

93

<.001

After obtaining CT scan

6.1

7

 Other

6

12.3

14

CT imaging frequency over past decade  Increased

16 17 26

5.3

6

<.001

 Decreased  Unchanged

43.4 51.3

49 58

Abbreviations: ARS, American Rhinologic Society; ASPO, American Society of Pediatric Otolaryngology; CT, computed tomography.

members. This may be due to the fact that rhinologists more commonly manage adults with CRS, for whom imaging is typically performed prior to any surgical management. Pediatric otolaryngologists may also be more concerned with the increased risks of radiation-induced malignancy associated with radiologic studies, as described in a recent systematic review. 9 In addition, since adenoidectomy alone has been shown in a meta-analysis to improve symptoms or outcomes in 70% of PCRS patients, 8 pediatric otolaryngol- ogists may feel that no further intervention or workup, such as CT imaging, is necessary until adenoidectomy has been first performed. One strength of this project was the parallel survey design administered to 2 differently trained groups, but this study is subject to several limitations. The survey addressed only PCRS in otherwise healthy patients, and potential dif- ferences in treatment for patients with cystic fibrosis, immunodeficiency, or primary ciliary dyskinesia were not addressed. 10 In addition, there were differences between ARS and ASPO groups in terms of the percentage of

respondents who were in academic practice and who were fellowship trained, and this may limit the generalizability of the comparison between groups. Finally, the survey assessed patients aged 6 months to 12 years; it is possible that ASPO members more commonly manage patients toward the younger end of this range, which may have affected their treatment decisions. Conclusions This survey evaluates the current practice patterns of ASPO members in treating PCRS and compares these data to recently published data among ARS membership. PCRS management by both groups is largely in concor- dance with published consensus statements. Overall man- agement is similar between both groups, but there are differences in management between the 2 groups, includ- ing oral steroid use, relative order of CT versus perform- ing adenoidectomy for medically refractory disease, and including concomitant procedures with adenoidectomy

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