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## Complete Summary

#### GUIDELINE TITLE

Sinusitis\--child.

#### BIBLIOGRAPHIC SOURCE(S)

McAlister WH, Strain JD, Cohen HL, Fordham L, Gelfand MJ, Gunderman R,
Slovis TL, Smith WL, Rodriguez W, Expert Panel on Pediatric Imaging.
Sinusitis\--child. \[online publication\]. Reston (VA): American College
of Radiology (ACR); 2006. 7 p. \[51 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: McAlister WH, Parker BR,
Kushner DC, Babcock DS, Cohen HL, Gelfand MJ, Hernandez RJ, Royal SA,
Slovis TL, Smith WL, Strain JD, Strife JL, Kanda MB, Myer E, Decter RM,
Moreland MS. Sinusitis in the pediatric population. American College of
Radiology. ACR Appropriateness Criteria. Radiology 2000
Jun;215(Suppl):811-18.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s) for which important revised regulatory and/or
warning information has been released.

-   [May 23, 2007, Gadolinium-based Contrast
    Agents](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Gadolinium):
    The addition of a boxed warning and new warnings about the risk of
    nephrogenic systemic fibrosis (NSF) to the full prescribing
    information for all gadolinium-based contrast agents (GBCAs).

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Sinusitis

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation

#### CLINICAL SPECIALTY

Allergy and Immunology\
Family Practice\
Otolaryngology\
Pediatrics\
Radiology

#### INTENDED USERS

Health Plans\
Hospitals\
Managed Care Organizations\
Physicians\
Utilization Management

#### GUIDELINE OBJECTIVE(S)

To evaluate the appropriateness of initial radiologic examinations for
sinusitis in the pediatric population

#### TARGET POPULATION

Children with sinusitis

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  X-ray, paranasal sinuses

2.  Computed tomography (CT)

    -   Cranial, including sinuses and orbits with contrast

    -   Coronal, paranasal sinuses

3.  Magnetic resonance imaging (MRI), paranasal sinuses, multiple views 
    with contrast

4.  Ultrasound (US), paranasal sinuses

#### MAJOR OUTCOMES CONSIDERED

Utility of radiologic examinations in differential diagnosis

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The guideline developer performed literature searches of recent
peer-reviewed medical journals, and the major applicable articles were
identified and collected.

#### NUMBER OF SOURCE DOCUMENTS

The total number of source documents identified as the result of the
literature search is not known.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Not Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not stated

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

One or two topic leaders within a panel assume the responsibility of
developing an evidence table for each clinical condition, based on
analysis of the current literature. These tables serve as a basis for
developing a narrative specific to each clinical condition.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus (Delphi)

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Since data available from existing scientific studies are usually
insufficient for meta-analysis, broad-based consensus techniques are
needed for reaching agreement in the formulation of the appropriateness
criteria. The American College of Radiology (ACR) Appropriateness
Criteria panels use a modified Delphi technique to arrive at consensus.
Serial surveys are conducted by distributing questionnaires to
consolidate expert opinions within each panel. These questionnaires are
distributed to the participants along with the evidence table and
narrative as developed by the topic leader(s). Questionnaires are
completed by the participants in their own professional setting without
influence of the other members. Voting is conducted using a scoring
system from 1-9, indicating the least to the most appropriate imaging
examination or therapeutic procedure. The survey results are collected,
tabulated in anonymous fashion, and redistributed after each round. A
maximum of three rounds is conducted and opinions are unified to the
highest degree possible. Eighty percent agreement is considered a
consensus. This modified Delphi technique enables individual, unbiased
expression, is economical, easy to understand, and relatively simple to
conduct.

If consensus cannot be reached by the Delphi technique, the panel is
convened and group consensus techniques are utilized. The strengths and
weaknesses of each test or procedure are discussed and consensus reached
whenever possible. If \"No consensus\" appears in the rating column,
reasons for this decision are added to the comment sections.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

One study found that the cost of magnetic resonance imaging (MRI) was
comparable to the costs of plain radiographs and computed tomography
(CT), but this is not typically the case.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Criteria developed by the Expert Panels are reviewed by the American
College of Radiology (ACR) Committee on Appropriateness Criteria.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**ACR Appropriateness Criteria®**

**Clinical Condition: Sinusitis \-- Child**

**Variant 1: Nasal discharge and fever \<10 days\' duration.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, paranasal     2                   One to four projections. See
  sinuses                                  literature review below.

  CT cranial,          2                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  CT, coronal,         2                    
  paranasal sinuses                        

  MRI, paranasal       2                    
  sinuses, multiple                        
  views with contrast                      

  US, paranasal        1                   A or B mode or real time.
  sinuses                                  

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 2: Purulent nasal discharge and fever \>10 days\' duration.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT, coronal,         8                    
  paranasal sinuses                        

  X-ray, paranasal     3                   One to four projections.
  sinuses                                  

  CT cranial,          2                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  MRI, paranasal       2                    
  sinuses, multiple                        
  views with contrast                      

  US, paranasal        1                   A or B mode or real time.
  sinuses                                  

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 3: Headache, no nasal discharge.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  X-ray, paranasal     2                   One to four projections.
  sinuses                                  

  US, paranasal        2                   A or B mode or real time.
  sinuses                                  

  CT cranial,          2                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  CT, coronal,         2                    
  paranasal sinuses                        

  MRI, paranasal       2                    
  sinuses, multiple                        
  views with contrast                      

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 4: Recurrent or persistent clinical sinusitis.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT, coronal,         8                    
  paranasal sinuses                        

  X-ray, paranasal     2                   One to four projections.
  sinuses                                  

  CT cranial,          2                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  MRI, paranasal       2                    
  sinuses, multiple                        
  views with contrast                      

  US, paranasal        1                   A or B mode or real time.
  sinuses                                  

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 5: Poorly responding asthma or history of atopia with
persistent nasal discharge.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT, coronal,         6                    
  paranasal sinuses                        

  X-ray, paranasal     2                    
  sinuses                                  

  CT cranial,          2                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  MRI, paranasal       2                    
  sinuses, multiple                        
  views with contrast                      

  US, paranasal        1                   A or B mode or real time.
  sinuses                                  

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 6: Preoperative evaluation for functional endoscopic sinus
surgery.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT, coronal,         9                    
  paranasal sinuses                        

  X-ray, paranasal     2                   One to four projections.
  sinuses                                  

  CT cranial,          2                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  MRI, paranasal       2                    
  sinuses, multiple                        
  views with contrast                      

  US, paranasal        1                   A or B mode or real time.
  sinuses                                  

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 7: Suspected complication of sinusitis (e.g., orbital
cellulitis).**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT cranial,          9                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  CT, coronal,         4                   Use IV contrast material.
  paranasal sinuses                        

  X-ray, paranasal     2                   One to four projections.
  sinuses                                  

  MRI, paranasal       2                   For problem solving and suspected
  sinuses, multiple                        intracranial disease involvement.
  views with contrast                      

  US, paranasal        1                   A or B mode or real time.
  sinuses                                  

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

**Variant 8: Complex sinus disease; rule out fungal sinusitis.**

  ---------------------------------------------------------------------------
  **Radiologic Exam    **Appropriateness   **Comments**
  Procedure**          Rating**            
  -------------------- ------------------- ----------------------------------
  CT cranial,          9                    
  including sinuses                        
  and orbits with                          
  contrast                                 

  MRI, paranasal       9                    
  sinuses, multiple                        
  views with contrast                      

  CT, coronal,         4                   Use IV contrast material.
  paranasal sinuses                        

  X-ray, paranasal     2                   One to four projections.
  sinuses                                  

  US, paranasal        1                   A or B mode or real time.
  sinuses                                  

  ***Appropriateness                       
  Criteria Scale*\                         
  1 2 3 4 5 6 7 8 9\                       
  1 = Least                                
  appropriate 9 = Most                     
  appropriate**                            
  ---------------------------------------------------------------------------

Note: Abbreviations used in the tables are listed at the end of the
\"Major Recommendations\" field.

Sinusitis is a common problem in the pediatric population. The
underlying factors that may lead to sinusitis in children include nasal
airway obstruction, immunodeficiencies, alterations in the mucosa of the
sinuses and nasal passageways, ciliary dysfunction, and underlying
conditions such as cystic fibrosis, allergic rhinitis, and immotile
cilia syndrome. The growing number of children in day care centers has
led to an increase in upper respiratory infections, which usually
precede acute sinusitis. Recognition of the importance of sinus disease
in children has been stimulated by the realization that sinus disease
can have a negative impact on chronic pulmonary disease and is often a
major complication of primary and acquired immunodeficiencies, the
incidence and recognition of which are increasing. Not to be overlooked
is the social and economic importance of sinusitis---parents often
missing work to care for their children.

Although physicians vary in their understanding and ability to diagnose
sinusitis clinically, a number of publications have detailed the signs
and symptoms of acute, recurrent, and chronic sinusitis. The findings of
sinusitis, especially chronic recurrent sinusitis, are nonspecific. The
most common signs and symptoms of acute sinusitis are upper respiratory
infection with cough and purulent nasal drainage persisting beyond 10
days. Infants and children with acute sinusitis almost always have
purulent nasal discharge with acute sinusitis. Also considered is the
patient who has severe symptoms and signs, including a temperature
greater than 102 degrees F (39 degrees C) and a purulent nasal discharge
present concurrently for at least 3 to 4 consecutive days in an ill
child. Acute sinusitis is a clinical diagnosis which may not require
imaging, especially in children less than 6 years of age. In patients
with chronic sinusitis or rhinosinusitis with symptoms lasting more than
90 days, one must consider the possibility that they are associated with
or secondary to asthma, gastroesophageal reflux, cystic fibrosis, or
allergic rhinitis. Allergic patients have a higher incidence and more
severe disease seen on computed tomography (CT) examinations of the
sinuses. The same is true for asthma patients. The precise role of
imaging for the diagnosis and management of chronic or recurrent
sinusitis, is unclear, including the CT classifications of disease
staging, and will therefore not be included in the clinical condition
variants.

Two main controversies surround imaging of sinusitis in the pediatric
population. The first concerns the use of plain radiographs versus
coronal CT scans. Although they are less costly and more widely
available, plain radiographs both underdiagnose and overdiagnose soft
tissue changes in the paranasal sinuses. In addition, the Caldwell
projection does not localize ethmoid disease, and the Waters projection
does not show ethmoid involvement. Demonstration and localization of
disease are essential for endoscopic sinus surgery; therefore, plain
radiographs cannot be used as a guide for this procedure. Lateral sinus
radiographs are of little value in patients under 4 years of age.
Coronal sinus CT is the recommended examination for imaging persistent
or chronic sinusitis in patients of any age, because it accurately
depicts the sinus anatomy, including soft tissue changes, anatomic
variations, the ostiomeatal complex, and complications, especially those
involving the orbit or intracranial structures. The fourth view, the
submentovertex, does not contribute to the depiction of soft tissue
changes in the paranasal sinuses.

An even greater controversy in imaging pediatric sinusitis is the high
incidence of soft tissue findings noted on plain radiographs, CT, or
magnetic resonance imaging (MRI) examinations found in patients who have
no clinical evidence of sinus disease but who have undergone these
examinations for other reasons. Incidences of 33%-50% have been
reported. The common cold acutely produces mucosal abnormalities in
sinuses, including the ostiomeatal area and nasal passageways, in the
majority of adults. This incidence is even higher in infants and
children and, indeed, was 97% in a study involving infants who had a
cold in the two weeks preceding cranial CT done for other reasons.
Another study demonstrated an 88% incidence of soft tissue changes in
sinuses associated with viral respiratory infections. However, acute
viral rhinosinusitis does predispose the patient to acute bacterial
sinusitis. MRI studies have also shown that soft tissue changes in
sinuses can last months following an acute infection. Soft tissue
abnormalities on CT scans are dynamic and can change from day to day.
Clinical correlation with imaging findings is critical for accurate
evaluation of these findings.

If suspicion exists for complications of sinusitis such as preseptal or
postseptal cellulitis, subperiosteal abscess, orbital cellulitis or
abscess, cavernous sinus thrombosis, osteomyelitis of the frontal bone,
subdural empyema, epidural or brain abscess, meningitis, brain
infarction, or myotic aneurysm, then cranial CT including the brain and
sinuses is indicated. MRI with gadolinium is especially useful if
intracranial involvement is suspected.

MRI of the paranasal sinuses beautifully shows mucosal thickening,
differentiates mucosal thickening from sinus secretions, and is not
associated with ionizing radiation, but it is not feasible as a primary
imaging modality for pediatric sinusitis because of its higher costs,
its limited availability, frequent need for sedation in infants and
children, and the lack of bony detail of the ostiomeatal complex felt to
be a major factor in sinusitis. MRI of the sinuses can play a role in
evaluating the complications of sinusitis, such as fungal involvement of
the sinuses and intracranial extension, as well as in excluding tumor in
patients with opacified sinuses. In one study the cost of MRI was
comparable to the costs of plain radiographs and CT, but this is not
typically the case.

Conventional tomography of the sinuses and nuclear medicine studies are
rarely indicated. Control studies using ultrasound of the sinuses have
shown that this modality lacks sufficient sensitivity and specificity
and is not recommended.

Plain radiographs of the sinuses may be useful for confirming soft
tissue findings in patients with clinical sinusitis, but they have very
low specificity. They can be used on patients with headaches in whom the
diagnosis of sinusitis is considered to be a clinical possibility. Plain
radiographs of the sinuses can assist in excluding sinus disease when
the clinical manifestations are unclear.

Coronal CT scans are the gold standard for diagnosing soft tissue
findings in the sinuses. However, the high incidence of soft tissue
abnormalities in the sinuses of infants and children with intercurrent
or recent upper respiratory tract infections necessitates the
correlation of clinical and imaging findings. In addition, the incidence
on CT of anatomic sinus variations, Haller cells, concha bullosa, and so
forth, along with the distribution of diseases within the sinuses is
similar in asymptomatic infants and children, such as those with
recurrent sinusitis.

Coronal CT scans should be obtained before functional endoscopic sinus
surgery (FESS) as they provide a road map for surgery. Controversies
certainly exist not only about imaging for suspected sinusitis but also
regarding management of the disease---antibiotic therapy, duration of
therapy, adjunct therapies, role of FESS, etc. A randomized placebo
controlled study of clinically diagnosed acute uncomplicated sinusitis
showed no clinical benefit from antibiotic therapy. There is poor
concordance between clinical signs and symptoms and the imaging and
clinical results of FESS.

Recommendations are as follows:

1.  The diagnosis of acute and chronic sinusitis should be made
    clinically, not on the basis of imaging findings alone.

2.  When acute sinusitis is diagnosed and appropriately treated, no
    imaging studies are indicated if full clinical resolution occurs.

3.  Patients with acute sinusitis persisting after 10 days of
    appropriate therapy, or with chronic sinusitis, and in whom imaging
    evaluation is desired, should undergo coronal CT scans of the
    sinuses regardless of their age.

4.  The use of plain radiographs in evaluating of sinusitis should be
    discouraged unless exceptional circumstances warrant it. If plain
    radiographs are performed, only Waters and Caldwell views are
    recommended for patients younger than 4 years of age; for older
    patients, a lateral view is obtained. The lateral view should be
    performed with cross-table technique if the Waters view cannot be
    obtained with the patient upright.

5.  Cranial CT with contrast, to include the sinuses, is indicated for
    suspected complications of bacterial sinusitis.

**Abbreviations**

-   CT, computed tomography

-   IV, intravenous

-   MRI, magnetic resonance imaging

-   US, ultrasound

#### CLINICAL ALGORITHM(S)

Algorithms were not developed from criteria guidelines.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations are based on analysis of the current literature and
expert panel consensus.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Selection of appropriate radiologic imaging procedures for diagnosis of
sinusitis in the pediatric population

#### POTENTIAL HARMS

High incidence of soft tissue findings noted on plain radiographs,
computed tomography (CT), and magnetic resonance imaging (MRI)
examinations in patients who have no clinical evidence of sinus disease.
Clinical correlation with imaging findings is critical for accurate
evaluation of these findings.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

An American College of Radiology (ACR) Committee on Appropriateness
Criteria and its expert panels have developed criteria for determining
appropriate imaging examinations for diagnosis and treatment of
specified medical condition(s). These criteria are intended to guide
radiologists, radiation oncologists, and referring physicians in making
decisions regarding radiologic imaging and treatment. Generally, the
complexity and severity of a patient\'s clinical condition should
dictate the selection of appropriate imaging procedures or treatments.
Only those exams generally used for evaluation of the patient\'s
condition are ranked. Other imaging studies necessary to evaluate other
co-existent diseases or other medical consequences of this condition are
not considered in this document. The availability of equipment or
personnel may influence the selection of appropriate imaging procedures
or treatments. Imaging techniques classified as investigational by the
U.S. Food and Drug Administration (FDA) have not been considered in
developing these criteria; however, study of new equipment and
applications should be encouraged. The ultimate decision regarding the
appropriateness of any specific radiologic examination or treatment must
be made by the referring physician and radiologist in light of all the
circumstances presented in an individual examination.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Personal Digital Assistant (PDA) Downloads

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

McAlister WH, Strain JD, Cohen HL, Fordham L, Gelfand MJ, Gunderman R,
Slovis TL, Smith WL, Rodriguez W, Expert Panel on Pediatric Imaging.
Sinusitis\--child. \[online publication\]. Reston (VA): American College
of Radiology (ACR); 2006. 7 p. \[51 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1995 (revised 2006)

#### GUIDELINE DEVELOPER(S)

American College of Radiology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

The American College of Radiology (ACR) provided the funding and the
resources for these ACR Appropriateness Criteria®.

#### GUIDELINE COMMITTEE

Committee on Appropriateness Criteria, Expert Panel on Pediatric Imaging

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Panel Members*: William H. McAlister, MD; John D. Strain, MD; Harris L.
Cohen, MD; Lynn Fordham, MD; Michael J. Gelfand, MD; Richard Gunderman,
MD, PhD; Thomas L. Slovis, MD; Wilbur L. Smith, MD; William Rodriguez,
MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: McAlister WH, Parker BR,
Kushner DC, Babcock DS, Cohen HL, Gelfand MJ, Hernandez RJ, Royal SA,
Slovis TL, Smith WL, Strain JD, Strife JL, Kanda MB, Myer E, Decter RM,
Moreland MS. Sinusitis in the pediatric population. American College of
Radiology. ACR Appropriateness Criteria. Radiology 2000
Jun;215(Suppl):811-18.

The appropriateness criteria are reviewed annually and updated by the
panels as needed, depending on introduction of new and highly
significant scientific evidence.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American College of Radiology (ACR) Web
site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonPediatricImaging/SinusitisChildDoc8.aspx).

ACR Appropriateness Criteria® *Anytime*, *Anywhere*™ (PDA application).
Available from the [ACR Web
site](http://www.acr.org/SecondaryMainMenuCategories/ACRStore/FeaturedCategories/QualityandSafety/ac_pda.aspx).

Print copies: Available from the American College of Radiology, 1891
Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   ACR Appropriateness Criteria®. Background and development. Reston
    (VA): American College of Radiology; 2 p. Electronic copies:
    Available in Portable Document Format (PDF) from the [American
    College of Radiology (ACR) Web
    site](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/background_dev.aspx).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on March 25, 1999. The information
was verified by the guideline developer on September 9, 1999. The
summary was updated on February 12, 2002. The information was verified
again by the guideline developer on March 25, 2002. This summary was
updated by ECRI on August 17, 2006. This summary was updated by ECRI
Institute on May 17, 2007 following the U.S. Food and Drug
Administration (FDA) advisory on Gadolinium-based contrast agents. This
summary was updated by ECRI Institute on June 20, 2007 following the
U.S. Food and Drug Administration (FDA) advisory on gadolinium-based
contrast agents.

#### COPYRIGHT STATEMENT

Instructions for downloading, use, and reproduction of the American
College of Radiology (ACR) Appropriateness Criteria® may be found on the
[ACR Web
site.](http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/ACRAppropriatenessCriteriaTermsandConditionsDoc1.aspx)

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008