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

Tzyynong L Friesen1,2, Matt Hall3, Nanda Ramchandar4

  • 1Department of Otolaryngology, University of California San Diego, San Diego, California, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|March 20, 2023
PubMed

Insights

Surgical management for acute mastoiditis decreased over time in US pediatric centers. Despite declining surgery rates, patient outcomes remained excellent, with younger, complicated cases more likely to receive surgical treatment.

Area of Science:

  • Otolaryngology
  • Pediatric Medicine
  • Health Services Research

Background:

  • Optimal management for acute mastoiditis lacks consensus.
  • Existing research primarily consists of small, single-institution retrospective studies.
  • There is a need for broader analysis of treatment trends and outcomes.

Purpose of the Study:

  • To analyze the treatment of acute mastoiditis in US pediatric centers.
  • To examine changes in management strategies over time.
  • To compare outcomes between surgical and nonsurgical approaches.

Main Methods:

  • Retrospective analysis of an administrative database (Pediatric Health Information System).
  • Inclusion of patients aged ≤18 years diagnosed with acute mastoiditis from 2010-2019.
  • Statistical analysis using Cochran-Armitage Trend Test, chi-squared, and Wilcoxon rank sum tests.

Main Results:

  • A total of 2170 patients were analyzed, with 57.5% undergoing surgery.
  • Significant decreases observed in myringotomy (64% to 47%) and mastoidectomy (22% to 10%) rates from 2010 to 2019.
  • Surgically treated patients were younger, more likely to have complications, and had longer hospital stays and higher ICU utilization, yet similar readmission and mortality rates.

Conclusions:

  • Acute mastoiditis treatment has evolved, with a notable decline in surgical interventions.
  • Surgical management is more common in younger patients with complications.
  • Overall outcomes for acute mastoiditis remain favorable regardless of surgical approach.
Abstract

Keywords:
databasemastoidectomypediatric mastoiditistreatment

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