Complications in Pediatric Acute Mastoiditis: HCUP KID Analysis

2021 ◽  
pp. 019459982198963
Author(s):  
Nicole Favre ◽  
Vijay A. Patel ◽  
Michele M. Carr
Keyword(s):  
Otitis Media ◽  
The United States ◽  
National Database ◽  
Ventilation Tube ◽  
Acute Mastoiditis ◽  
Drainage Procedure ◽  
Intracranial Complication ◽  
Subperiosteal Abscess ◽  
Management Of Complications ◽  
Total Charges

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.

Acute mastoiditis in children: presentation and long term consequences

2007 ◽  
Vol 122 (3) ◽  
pp. 233-237 ◽  
Author(s):  
F Glynn ◽  
L Osman ◽  
M Colreavy ◽  
H Rowley ◽  
T P O Dwyer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Previous History ◽  
Acute Otitis Media ◽  
Cell System ◽  
Acute Mastoiditis ◽  
Subperiosteal Abscess ◽  
Lack Of Information ◽  
Cortical Mastoidectomy ◽  
One Year

AbstractAcute mastoiditis, a destructive bacterial infection of the mastoid bone and air cell system, is relatively uncommon today but remains a potentially serious condition. There is a lack of information in the literature regarding the long term otological problems that children may face following an episode of this condition.Objectives:Our aim was to examine the presentation, complications and hospital course in this patient population, and to ascertain whether these patients had long term otological problems.Methods:We retrospectively reviewed the medical records of all patients presenting with acute mastoiditis between January 1990 and December 2005. Patients' parents were contacted by telephone and questioned about further otological problems.Results:Twenty-nine patients were included in the study, and 27 of these patients' parents were contactable to complete the telephone questionnaire. Sixty-nine per cent of children had no previous history of acute otitis media prior to presentation. Forty-five per cent of patients had received oral antibiotics prior to presentation. Sixty-two per cent of patients developed complications, i.e. a subperiosteal abscess or failure to respond to medical therapy, resulting in the need for surgical intervention (in the form of incision and drainage of periosteal abscess, cortical mastoidectomy, or grommet insertion). Mean follow up of patients was eight years and one month; five (17 per cent) patients had been followed up for less than one year. Two (7 per cent) patients developed a further episode of mastoiditis within six weeks of initial presentation, both of whom required cortical mastoidectomy. Three (10 per cent) patients had further problems with recurrent acute otitis media, requiring tympanostomy tube insertion. One patient required a modified radical mastoidectomy for cholesteatoma (15 years later). Twenty-two patients (91 per cent) had been followed up for longer than one year; these patients had subjectively normal hearing and were asymptomatic at the time of study.Conclusion:The majority of patients who had suffered an episode of acute mastoiditis had no adverse long term otological sequelae.

Acute mastoiditis in infants aged six months or younger

2020 ◽  
Vol 134 (8) ◽  
pp. 721-726
Author(s):  
P Zavras ◽  
S Potamianos ◽  
M-Z Psarommati ◽  
I Psarommatis
Keyword(s):  
Retrospective Review ◽  
Treatment Options ◽  
Age Group ◽  
Older Children ◽  
Acute Mastoiditis ◽  
Drainage Procedure ◽  
Algorithmic Approach ◽  
Subperiosteal Abscess ◽  
Bibliographic Data ◽  
Intracranial Complications

AbstractObjectiveBibliographic data for the management of acute mastoiditis in infants aged six months or less are very limited. This study investigated the presenting symptomatology, diagnostic and treatment options, and final outcomes in this age group.MethodA retrospective review was conducted of all infants aged six months or less suffering from acute mastoiditis, admitted to our department between 2007 and 2017.ResultsEleven infants were identified. All of them developed the typical symptomatology of acute mastoiditis, while a higher rate of subperiosteal abscess formation was observed. Imaging was necessary in three cases only. Parenteral antibiotics and myringotomy were applied in all infants. A drainage procedure was also included in the infants with a subperiosteal abscess. Antrotomy was reserved for non-responsive cases. No intracranial complications were observed. All infants were cured without further complications or sequelae.ConclusionAcute mastoiditis in infants aged six months or less can be safely diagnosed and treated using a standardised algorithmic approach, similar to that used for older children.

scholarly journals Study of demography and clinical profile of extracranial complications of chronic suppurative otitis media

2018 ◽  
Vol 4 (4) ◽  
pp. 977
Author(s):  
Mallikarjun Patil ◽  
Shashidhar Suligavi ◽  
S. S. Doddamani
Keyword(s):  
Otitis Media ◽  
Low Income ◽  
Facial Palsy ◽  
Income Group ◽  
Chronic Suppurative Otitis Media ◽  
Acute Mastoiditis ◽  
Suppurative Otitis Media ◽  
Subperiosteal Abscess ◽  
Extracranial Complications ◽  
Age Range

<p class="abstract"><strong>Background:</strong> The complications of chronic suppurative otitis media (CSOM) are still prevalent in the developing countries like India. They pose a great challenge in the management. The objective of the study was to study the demographic pattern, symptomatology and pattern of extracranial complications of CSOM.</p><p class="abstract"><strong>Methods:</strong> Patients of both sexes presenting with extra cranial complications of chronic suppurative otitis media were included. A proforma drafted for the study of these patients was used. The patients were subjected to investigations to confirm the diagnosis.  </p><p class="abstract"><strong>Results:</strong> In our study of 25 cases of extra cranial complications of CSOM, there were 14 females and 11 males.8 cases were in the age range of 11-20 years. Of the 25 cases, 22 belonged to the low income group and 3 to mid income group. Most common symptoms at presentation were otorrhoea, hearing loss, ear ache, postaural swelling and postaural discharge. Most cases were from rural area. Regarding extracranial complications, 10 cases (40%) had subperiosteal abscess, 4 (16%) mastoid fistula, 2 (8%) acute mastoiditis, 3 (12%) labyrinthine fistula, 2 (8%) facial palsy alone and 3 (12%) had multiple extracranial complications (facial palsy with mastoid fistula). Total facial palsy cases were 5 (20%).</p><p><strong>Conclusions:</strong> Most common age group affected were less than 20 yrs of age, females more affected than males, Low socio-economic group children were affected commonly. Ear discharge and ear pain were common presenting complaints. Subperiosteal abscess was most common extracranial complication followed by mastoid fistula, acute mastoiditis and facial palsy. </p>

scholarly journals THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Haley E. Smith ◽  
Madeline M. Lyons ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
National Database ◽  
Control Group ◽  
Meniscal Allograft Transplantation ◽  
Children's Hospitals ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Children’S Hospitals

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

2021 ◽  
pp. 000348942110157
Author(s):  
Jennifer L. McCoy ◽  
Ronak Dixit ◽  
R. Jun Lin ◽  
Michael A. Belsky ◽  
Amber D. Shaffer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Private Insurance ◽  
Chronic Otitis Media ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Median Income ◽  
Public Insurance ◽  
Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

System-wide seismic vulnerability of aging multiple-span multiple-girder bridges in low-to-moderate seismic hazard regions

2021 ◽  
Vol 37 (1_suppl) ◽  
pp. 1626-1651
Author(s):  
John E Lens M.EERI ◽  
Mandar M Dewoolkar ◽  
Eric M Hernandez M.EERI
Keyword(s):  
United States ◽  
Seismic Hazard ◽  
Cross Sections ◽  
Seismic Vulnerability ◽  
Time History ◽  
The United States ◽  
National Database ◽  
Eastern United States ◽  
Girder Bridges ◽  
The Status

This article describes the approach, methods, and findings of a quantitative analysis of the seismic vulnerability in low-to-moderate seismic hazard regions of the Central and Eastern United States for system-wide assessment of typical multiple span bridges built in the 1950s through the 1960s. There is no national database on the status of seismic vulnerability of bridges, and thus no means to estimate the system-wide damage and retrofit costs for bridges. The study involved 380 nonlinear analyses using actual time-history records matched to four representative low-to-medium hazard target spectra corresponding with peak ground accelerations from approximately 0.06 to 0.3 g. Ground motions were obtained from soft and stiff site seismic classification locations and applied to models of four typical multiple-girder with concrete bent bridges. Multiple-girder bridges are the largest single category, comprising 55% of all multiple span bridges in the United States. Aging and deterioration effects were accounted for using reduced cross-sections representing fully spalled conditions and compared with pristine condition results. The research results indicate that there is an overall low likelihood of significant seismic damage to these typical bridges in such regions, with the caveat that certain bridge features such as more extensive deterioration, large skews, and varied bent heights require bridge-specific analysis. The analysis also excludes potential damage resulting from liquefaction, flow-spreading, or abutment slumping due to weak foundation or abutment soils.

scholarly journals EPIDEMIOLOGY OF PEDIATRIC CARTILAGE RESTORATION PROCEDURES IN THE UNITED STATES: INSURANCE AND GEOGRAPHY PLAY A ROLE

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Tyler B. Hall ◽  
Max J. Hyman ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
Statistical Significance ◽  
Private Insurance ◽  
Univariate Analysis ◽  
The United States ◽  
National Database ◽  
The West ◽  
Cartilage Restoration ◽  
Common Diagnosis

Background: A number of surgical options are available for sizeable articular cartilage lesions of the knee. These include osteochondral autograft (OAU) or allograft (OAL) transfer, or autologous chondrocyte implantation (ACI). In the pediatric population, there is little data on the patients undergoing these procedures or evidence to support one technique over another, which may lead to variation in preferred practice. Hypothesis/Purpose: The purpose of this study is to analyze the epidemiology of children and adolescents undergoing OAU, OAL, and ACI in the United States, with attention to variation along the lines of demographic and geographic factors. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing OAU, OAL, and ACI between 2012 and 2018. Demographic information was collected for each subject. United States Census guidelines were used to categorize hospitals geographically into regions. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 809 subjects with a mean age of 15.4±2.4 years were included in the analysis. Of these, 393 (48.6%) underwent OAL, 339 (41.9%) underwent OAU, and 77 (9.5%) underwent ACI. The most common diagnosis at the time of surgery was osteochondritis dissecans in 360 patients (44.5%) followed by an associated cruciate ligament injury in 126 (15.6%) and patellar instability in 98 (12.1%). After adjusting for confounders in a multivariate model, ACI was more 3.4 times more likely to be performed in patients with private insurance than those that were publicly insured (95% CI 1.5-7.5, p=0.002). Furthermore, a patient in this Northeast was 29.3 times more likely to undergo ACI than in the West (95% CI 4.0-217.4, p=0.001). OAU was performed most frequently in the West and Midwest (52.4% and 51.8% of the time, respectively; p<0.001). Univariate analysis also revealed differences along the lines of race, but these findings did not maintain statistical significance in multivariate analysis. Conclusion: In the United States, there is substantial variation in the procedures performed for cartilage restoration in children and adolescents. Though ACI is the least commonly selected operation overall, it is significantly more likely to be performed on patients with private insurance and those in the Northeast. OAU is the most commonly performed procedure in the West and Midwest.

Sign in / Sign up

Export Citation Format

Share Document