Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

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Object

Intracranial abscess is a very infrequent complication of sinusitis among children. Case series, mostly small and focusing on surgical treatment, have appeared in the literature, but there has been no study on the epidemiology of this condition, nor has there been any large-scale study on the intensity of therapy or outcomes.

Methods

Data were drawn from the Kids' Inpatient Databases for 1997, 2000, 2003, and 2006 and the National Inpatient Sample for 2001. Cases were defined by the conjunction between the diagnostic codes for intracranial abscess and those for acute or chronic sinusitis or mastoiditis.

Results

Eight hundred forty-seven hospital admissions were captured. Over the 10 years of the study, admission rates ranged between 2.74 and 4.38 per million children per year. Boys were affected much more commonly than girls. Black children were affected out of proportion to their presence in the population. The overall incidence seemed to peak in early adolescence. Sinogenic cases had a marked seasonal pattern peaking in winter, but no seasonal variation was seen for otogenic cases. Asthma comorbidity was more prevalent among sinogenic cases. The mortality rate was 2%, and death occurred only among sinogenic cases. Moreover, sinogenic cases tended to require more intensive therapy, as measured by the number of procedures, and there was a trend toward less favorable discharge dispositions. Older patients and black patients were less likely to be discharged directly to home. At least a quarter of the cases were managed without neurosurgical intervention. White patients were treated without neurosurgery more often than others.

Conclusions

Analysis of administrative data sets has yielded a descriptive picture of intracranial abscess complicating sinusitis among children, but the very low incidence of this condition impedes prospective clinical research directed at practical management issues.

Abbreviations used in this paper: HCUP = Healthcare Cost and Utilization Project; ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification; KID = Kids' Inpatient Database; LOS = length of stay; NIS = Nationwide Inpatient Sample.
Article Information

Contributor Notes

Address correspondence to: Joseph H. Piatt Jr., M.D., Division of Neurosurgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, Delaware 19803. email: jpiatt@nemours.org.
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