Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis

Abstract

Objective A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database. Study Design Retrospective review of 2016 Kids’ Inpatient Database, part of the Healthcare Cost and Utilization Project. Setting Academic, community, general, and pediatric specialty hospitals in the United States. Methods International Classification of Diseases, Tenth Revision, Clinical Modification code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges. Results In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely ( P < .001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS ( P < .001) and higher total charges ( P < .001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure ( P < .001) contributed significantly to LOS and total charges. Conclusion Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist.

Analysis of Neurogastrointestinal and Motility Disorders From the National Pediatric Database (Kid’s Inpatient Database): Exploring Demographic Access and Outcomes

“…Specifically, HCUP KID includes primary and secondary diagnoses, information on procedures, demographics, hospital-related associated factors, payment sources, total hospital charges, length of stay (LOS), and clinical outcomes to produce national estimates for over 7 million hospital stays per year. HCUP KID meets the criteria of Health Insurance Portability and Accountability Act since this publicly available database is deidentified and protects personal information (10). This study was deemed exempt from the Saint Louis University Institutional Review Board.…”

Acute Bacterial Sinusitis With Epidural and Subdural Involvement

“…In one retrospective review, the top two conditions of this category were reported to be sigmoid sinus thrombosis and intracranial abscess. Subperiosteal abscess was reported as the most common complication overall [6]. This case report describes an older pediatric patient who developed a superior sagittal thrombosis, subdural empyema, and epidural empyema after a suspected sinus infection.…”

Evolving Management of Acute Mastoiditis: Analysis of the Pediatric Health Information System Database

“…Not unexpectedly, those with intracranial complications had significantly longer length of stay (LOS), particularly those with a diagnosis of bacterial meningitis. 9 Historically, immediate surgical management in the form of cortical mastoidectomy with or without myringotomy tube placement has been advocated in addition to parenteral antibiotics. 10 Recently, there are growing reports of institutional success using more conservative surgical intervention or medical therapy alone.…”

“…A study of the 2016 Kids' Inpatient Database found that the most common mastoiditis complication was subperiosteal abscess (6.9%), followed by intracranial thrombophlebitis (5.3%), and intracranial abscess (3.9%). Not unexpectedly, those with intracranial complications had significantly longer length of stay (LOS), particularly those with a diagnosis of bacterial meningitis 9 …”