Pediatric Sinusitis: Complications and Management in the Emergency Department

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Publication Date: August 2024 (Volume 21, Number 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 08/01/2027.

Authors

Peer Reviewers

Abstract

Upper respiratory infections are some of the most common reasons for pediatric patients to present to the emergency department. A small percentage of these viral infections can evolve into acute bacterial sinusitis (ABS), which can be further complicated by the development of orbital, intracranial, and osseous complications. Differentiating between viral upper respiratory infections and ABS and identifying cases of ABS that require antibiotics can pose a challenge. This issue highlights the patterns of illness that are most consistent with ABS, based on the most current clinical practice guidelines. Additionally, this issue reviews clinical features that should raise suspicion for complicated disease and provides associated diagnostic and management pearls.

Case Presentations

A 5-year-old girl is brought into the ED by her father for persistent fevers and runny nose over the past 3 days...

• The father tells you he is worried that her fevers recur after 5 to 6 hours, despite oral antipyretics.
• On examination, the girl is playful and interactive. Her tympanic membranes are nonerythematous, but she is noted to have yellow nasal discharge. Her father asks for a prescription for antibiotics, since he had a similar illness last week and that was “the only thing that helped.”
• How should you approach counseling with this father regarding antibiotic use for his child?

A 4-year-old boy presents to the ED with a 1-week history of runny nose, nasal congestion, and low-grade fevers...

• His mother became concerned due to increased fevers up to 39.4°C and copious nasal discharge over the last day.
• The boy is running around and is interactive. He has thick green nasal discharge. His tympanic membranes are nonerythematous, and he has full range of motion of his neck.
• What treatment plan would be most appropriate for this patient?

A 13-year-old boy with severe headache and forehead swelling is brought in by EMS...

• The boy has a 1-week history of headache and nasal congestion, with new-onset forehead swelling and worsening pain over the past 24 hours. He is febrile with a temperature of 38.5°C and has notable swelling and tenderness of the forehead. He has difficulty with bilateral lateral gaze but is moving all extremities. He does not have nuchal rigidity or photophobia.
• What studies should you obtain for this patient? What is your diagnosis?

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EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.