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058. Analysis of Factors Associated with Length of Stay and Neurosurgical Intervention for Acute Sinusitis with Intracranial Extension

Authors: Torin W. Karsonovich, DO

Introduction:
Intracranial complications following acute sinusitis remains prevalent in the pediatric population. We sought to identify risk factors to determine which patients need surgery with otolaryngology (ENT) and which need both ENT and neurosurgical procedures, as well as factors associated with longer length of stay (LOS).Methods: Single center retrospective review over ten years. Electronic medical records identified children diagnosed with intracranial abscesses in association with acute sinusitis. Patients were dichotomized based on surgical treatment (ie. ENT only vs. ENT and neurosurgery). Patients were also dichotomized based on LOS (< vs > 8 days). Infectious organisms isolated from culture were reviewed.
Results:
Ninety-two children met inclusion criteria. The average age at diagnosis was 11.1 years and 56.7% (51/92) were male. The average duration of symptoms at presentation was 9.9 days (SD = 10.36). The average time to any procedure from presentation was 1.09 days (range 0-20). Streptococcus anginosus was the most common infectious agent, and was isolated in 63 (68.5%) patients. Abscess volume was significantly higher in patients undergoing both ENT and neurosurgery (8.16 vs 18.95cm3; p = 0.020), however abscess volume was not significantly different between patients requiring longer LOS (11.04 vs 12.11cm3, p=0.812). Initial CRP was significantly higher in the group that underwent both ENT and neurosurgical procedures (19.73 (SD = 12.27) vs 13.79mg/dL (SD = 10.86); p= 0.029) and was significantly higher in patients with longer LOS (11.87 vs 20.03mg/dL, p= < 0.001). White blood cell count (WBC) and erythrocyte sedimentation rate (ESR) at the time of diagnosis were not significantly different between treatment groups or for patients requiring longer LOS.
Conclusion:
Patients requiring both ENT and neurosurgical procedures for sinogenic intracranial abscesses were found to have larger abscesses at presentation and higher CRP levels. Higher CRP levels at diagnosis predicted longer LOS.