Clinical sinusitis in children attending primary care centers

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Abstract
To determine the proportion of children who meet the clinical criteria for the diagnosis of sinusitis among all children attending primary care pediatric practices, to explore the relationship between passive smoking and the occurrence of sinusitis and to study the role of antibiotics in the management of sinusitis. A prospective observational cohort study. Setting. Outpatient Pediatric Clinics of Jordan University of Science and Technology and Princess Rahma Teaching Hospital. Patients. All children ages 1 to 10 years presenting for any reason to participating practices. Physicians participating in this study completed a questionnaire on all children attending the primary care centers, detailing the presence of nasal congestion or discharge, the duration of symptoms, daytime cough and whether symptoms were improving. The presence or absence of smokers in the family was also recorded. Children meeting our clinical criteria for sinusitis were further evaluated for other signs and symptoms including the type of medication prescribed. The severity of symptoms was reassessed at 10-day follow-up after the first visit. The study population was composed of 3001 children, of whom 249 met our clinical criteria for diagnosis of sinusitis (8.3%; 95% confidence interval, 7.3 to 9.3%). The prevalence rate of clinical sinusitis was greater among children age 5 years and older than among those younger (9.3%vs. 7.2%, P = 0.04). Children exposed to passive smoking in the household had clinical sinusitis significantly more than those not exposed (68.8%vs. 1.2%, P = 0.00). Antibiotics were prescribed for 80% of children who fulfilled the clinical criteria for diagnosis of sinusitis. Marked improvement of symptoms at the 10-day follow-up visit was reported among those who received antibiotics compared with those who did not (91%vs. 21.4%, P = 0.00). Sinusitis is not an uncommon problem in children, passive smoking might be a contributing factor and a course of antibiotic therapy is beneficial.