Acute bacterial sinusitis (ABS) is a diagnosis that is made based on clinical criteria and has a low prevalence amongst children presenting with respiratory symptoms. Although a normal radiograph, CT, or MRI can help to rule out ABS, an abnormal result does not confirm the diagnosis. Given that many children will have abnormal imaging due to a viral upper respiratory infection during certain times of the year, combined with the potential for exposure to radiation, routine imaging is not recommended. Instances in which imaging would be warranted include if the child is immunocompromised, or if orbital, central nervous system, or other suppurative complications are present.
The American Academy of Pediatrics recommends diagnosing pediatric ABS when (1) cough, nasal discharge or both are persistent for >10 days without improvement; (2) there is worsening or new onset of cough, nasal discharge, or fever; or (3) there is a severe onset, with a fever greater ≥39℃, concurrently with purulent nasal discharge for at least 3 consecutive days. For more information:
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