American Academy of Pediatrics

Aggregate evidence quality: C; observational studies
Benefits	Identification of patients who may have been misdiagnosed, those at risk of complications, and those who require a change in management.
Harm	Delay of up to 72 hours in changing therapy if patient fails to improve.
Cost	Additional provider and caregiver time and resources.
Benefits-harm assessment	Preponderance of benefit.
Value judgments	Use of 72 hours to assess progress may result in excessive classification as treatment failures if premature; emphasis on importance of worsening illness in defining treatment failures.
Role of patient preferences	Caregivers determine whether the severity of the patient's illness justifies the report to clinician of the patient's worsening or failure to improve.
Intentional vagueness	None.
Exclusions	Patients with severe illness, poor general health, complicated sinusitis, immune deficiency, previous sinus surgery, or coexisting bacterial illness.
Strength	Recommendation.

Aggregate evidence quality: C; observational studies
Benefits	Identification of patients who may have been misdiagnosed, those at risk of complications, and those who require a change in management.
Harm	Delay of up to 72 hours in changing therapy if patient fails to improve.
Cost	Additional provider and caregiver time and resources.
Benefits-harm assessment	Preponderance of benefit.
Value judgments	Use of 72 hours to assess progress may result in excessive classification as treatment failures if premature; emphasis on importance of worsening illness in defining treatment failures.
Role of patient preferences	Caregivers determine whether the severity of the patient's illness justifies the report to clinician of the patient's worsening or failure to improve.
Intentional vagueness	None.
Exclusions	Patients with severe illness, poor general health, complicated sinusitis, immune deficiency, previous sinus surgery, or coexisting bacterial illness.
Strength	Recommendation.