3
Table 2. Summary of Key Action Statements (KAS)
Statement Action Grade
Diagnosis
1. Watchful waiting
for recurrent
throat infection
Clinicians should recommend watchful waiting for
recurrent throat infection if:
• there have been fewer than seven episodes in the
past year, OR
• fewer than five episodes per year in the past two
years, OR
• fewer than three episodes per year in the past
three years.
R-A-H
2. Recurrent throat
infection with
documentation
Clinicians may recommend tonsillectomy for
recurrent throat infection with a frequency of
at least seven episodes in the past year, or at
least five episodes per year for two years, or at
least three episodes per year for three years with
documentation in the medical record for each
episode of sore throat and one or more of the
following : temperature greater than 38.3°C
(101.0°F), cervical adenopathy, tonsillar exudate,
or positive test for group A beta-hemolytic
streptococcus.
O-B-M
3. Tonsillectomy for
recurrent infection
with modifying
factors
Clinicians should assess the child with recurrent
throat infection who does not meet criteria in
KAS2 for modifying factors that may nonetheless
favor tonsillectomy, which may include but are not
limited to multiple antibiotic allergies/intolerance,
PFAPA (periodic fever, aphthous stomatitis,
pharyngitis and adenitis), or history of more than
one peritonsillar abscess.
R-A-M
4. Tonsillectomy for
oSDB
Clinicians should ask caregivers of children with
oSDB and tonsillar hypertrophy about co-morbid
conditions that may improve aer tonsillectomy,
including growth retardation, poor school
performance, enuresis, asthma, and behavioral
problems.
R-B-M
5. Indications for
polysomnography
(PSG)
Before performing tonsillectomy, the clinician
should refer children with oSDB for PSG if they are
under two years of age, or if they exhibit any of the
following : obesity, Down syndrome, craniofacial
abnormalities, neuromuscular disorders, sickle cell
disease, or mucopolysaccharidoses.
R-B-H
