September 2019 HSC Section 1 Congenital and Pediatric Problems

Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2018; 108:163-167.

International Journal of Pediatric Otorhinolaryngology 108 (2018) 163–167

Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology

journal homepage: www.elsevier.com/locate/ijporl

Diagnosis and management of pediatric sinusitis: A survey of primary care, otolaryngology and urgent care providers Laurie Newton a , ∗ , Amanda Kotowski b , Melissa Grinker b , Robert Chun a a Children's Hospital of Wisconsin / Medical College of Wisconsin – Milwaukee, 8915 W. Cornell Ct., Milwaukee, WI 53226, United States b Children's Hospital of Wisconsin, 8915 W. Cornell Ct., Milwaukee, WI 53226, United States

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Objectives: The aims of this project were two-fold: 1) To assess pediatric primary care (PCP), pediatric otolar- yngology (ENT) and pediatric urgent care (UC) providers' perception of their adherence to the 2013 American Academy of Pediatrics (AAP) established guidelines for the diagnosis and management of acute bacterial rhi- nosinusitis (ABRS) in children 1 – 18 years old and 2) to assess the same providers' practice patterns in the diagnosis and management of pediatric chronic rhinosinusitis (PCRS). Method: A 21-item questionnaire (CVI .9) was designed by th investigators using Survey Monkey ® . The survey was emailed to pediatric providers (including physicians and advanced practice providers) in a Midwestern USA healthcare system (94 PCP, 25 UC, 19 ENT providers) from 20 pediatric primary care practices, 1 pediatric UC practice and 1 pediatric otolaryngology practice. Results: Diagnosis: The following diagnostic criteria are utilized: persistent nasal congestion/cough lasting > 10 days (95%), worsening of classic viral URI symptoms at days 5 – 7 (70%), severe onset and purulent nasal dis- charge for at least 3 consecutive days (45%). ENT will most commonly culture their patients. ENT providers (57%) approve of a nasal culture being obtained by PCPs. Management: Typically used antibiotics: amoxicillin (72%), Amoxicillin-clavulanic acid (98%), cefdinir (73%), azithromycin (15%). ENT providers will also use clarithromycin and Bactrim more often compared to PCPs. For PCN allergy patients, most providers choose cefdinir. Typical length of antibiotic therapy for providers is 10 days (70%) and 14 days (17%); ENT (21%) prescribes 7 days past any symptom compared to PCP (6%) and UC (5%). Use of adjuvant therapy is variable among the groups. Conclusion: This quality initiative project demonstrates that providers' diagnosis of ABRS is consistent with the 2013 AAP guidelines while variation in clinical management exists for both ABRS and PCRS. This survey de- monstrates the need to educate all providers on the current 2013 AAP guidelines and de fi ne practice across all settings.

Keywords: Pediatric Sinusitis Diagnosis Treatment Survey

1. Introduction

diagnosis and management of ABRS have not been e ff ectively trans- lated into routine practice [ 4 ]. More importantly, there is little research available to describe the adherence of pediatric providers to available guidelines for the management of ABRS in the pediatric population.

Acute bacterial rhinosinusitis (ABRS) is one of the most common conditions treated by primary care providers with an estimated pre- valence of 20 million cases of ABRS occurring annually in the United States [ 1 ]. ABRS is the fi fth most common condition for which an an- tibiotic is prescribed in the US despite the fact that symptoms consistent with this diagnosis are self-limiting in the majority of patients within 2 – 4 weeks [ 2 ]. Because viral upper respiratory infection (URI) and ABRS can have overlapping symptoms, antibiotics are grossly overused for the former, resulting in consequences that may include allergic re- actions, medication side e ff ects, increasing antibiotic resistance and increasing healthcare costs [ 1 , 3 ]. Studies suggest that guidelines for the

1.1. Background

Despite strong guideline recommendations to restrict the use of antibiotics when treating viral URI, studies that have looked at adult populations have shown only a modest decrease in antibiotic pre- scription rates [ 2 , 5 ]. Pynnonen and colleagues [ 5 ], for example, re- ported that 69.9% of patients with mild symptoms of short duration in their study where prescribed an antibiotic. This is lower than previous

∗ Corresponding author. E-mail addresses: lnewton@mcw.edu (L. Newton), akotowski@chw.org (A. Kotowski), mgrinker@chw.org (M. Grinker), rchun@mcw.edu (R. Chun).

https://doi.org/10.1016/j.ijporl.2018.02.039 Received 1 December 2017; Received in revised form 23 February 2018; Accepted 23 February 2018

Available online 27 February 2018 0165-5876/ © 2018 Elsevier B.V. All rights reserved.

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