ASPO095 - Management of Acute Mastoiditis: Analysis of the Pediatric Health Information System Database
Sunday, May 1, 2022
11:20 AM – 12:00 PM CT
Location: Landmark B
Tzyynong Friesen, MD1, Matt Hall, PhD2, Jay G. Berry, MD, MPH3, Wen Jiang, MD
1Otolaryngology, Univ. of California San Diego, San Diego, CA, 2Children's Hosp. Association, Lenexa, KS, 3General Pediatrics, Harvard Med. Sch., Boston, MA.
Clinical Professor of Surgery Rady Children's Hospital San Diego University of California San Diego, Department of Otolaryngology San Diego, California
Introduction: Although acute mastoiditis is the most common complication of acute otitis media, its optimal management remains controversial. Due to its low incidence, most studies are retrospective involving single-institutional experiences with small cohorts. Our objectives were to examine the treatment of acute mastoiditis by pediatric centers across the United States, report on factors associated with surgical versus non-surgical treatments, and assess the change in management over time.
Methods: A cross-sectional analysis was performed using data from the Pediatric Health Information System (PHIS) examining patients ≤18 years of age who were admitted with a principle diagnosis of acute mastoiditis from January 1, 2010 to December 31, 2019. The cohort included 38 tertiary care children’s hospitals across the United States. The Cochran-Armitage Trend Test was used to assess trends; chi-square and Wilcoxon Rank Sum tests compared outcomes between the surgical and non-surgical groups.
Results: A total of 2170 patients met inclusion criteria, with 1248 (57.5%) requiring surgical management. The rate of surgical procedures significantly decreased over time with ear tube rate from 64% in 2010 to 47% in 2019 (p <.001), and mastoidectomy rate from 22% in 2010 to 10% in 2019 (p <.001). The rate of mastoiditis-related complications was 13.8% and did not change over time (p=0.4). Patients treated surgically were more likely to be younger (p <.001), present with complications (20.4% v. 4.8%, p<.001), required longer length of stay (3.7 v. 2.3 days, p<.001), and higher Intensive Care Unit utilization (8.6% v. 2.2%, p<.001). However, the rate of 30-day readmission, Emergency Department return, or in-hospital mortality were equivalent.
Conclusion: Acute mastoiditis has been successfully treated with declining rates of surgery. Younger patients who present with complications are more likely to be managed surgically, and the overall outcomes remain excellent.