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Diagnosing acute mastoiditis in a Pediatric Emergency Department: a retrospective review
Chiara Bertolaso1, Ignazio Cammisa2, Nicola Orsini3
1Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.. chiara.bertolaso85@gmail.com.
Insights
Clinical symptoms like ear pain and auricle protrusion are strong indicators for diagnosing acute mastoiditis (AM) in children. This study suggests these signs may be more predictive than head CT scans.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Radiology
Background:
- Acute mastoiditis (AM) is a frequent complication of acute otitis media in children.
- Diagnostic criteria for AM lack consensus, leading to varied approaches in emergency departments.
- Concerns regarding radiation exposure in children prompt re-evaluation of diagnostic imaging like head CT.
Purpose of the Study:
- To evaluate the diagnostic necessity of head CT scans for acute mastoiditis in pediatric patients.
- To compare the predictive value of clinical symptoms versus head CT imaging in diagnosing AM.
Main Methods:
- Retrospective analysis of medical records for pediatric patients with suspected AM between 2014-2020.
- Review of clinical symptoms, head CT findings, laboratory values (WBC, CRP), complications, and discharge diagnoses.
- Application of multilogistic regression to assess the diagnostic role of clinical features and head CT.
Main Results:
- Otalgia (OR=5.01), protrusion of the auricle (OR=8.42), and mastoid hyperemia (OR=4.07) were significantly associated with higher AM probability.
- Head CT imaging showed an adjusted odds ratio of 3.09 (95% CI = 0.92-10.34) in diagnosis.
- Clinical signs demonstrated a stronger association with AM diagnosis compared to head CT findings.
Conclusions:
- Clinical features, including otalgia, auricle protrusion, and hyperemia, are highly predictive of acute mastoiditis in children.
- Head CT imaging may not be essential for diagnosing AM when clear clinical signs are present.
- Further research could refine diagnostic pathways, potentially reducing unnecessary radiation exposure in pediatric patients.
Abstract:
Background and aim Acute mastoiditis (AM) is a common complication of acute otitis media in children. There is currently no consensus on criteria for diagnosis. Head CT is the most frequent diagnostic tool used in the ED although the increasing awareness on the use of ionized radiations in children has questioned the use of CT imaging versus solely using clinical criteria. Our research aimed to understand if CT imaging was essential in making a diagnosis of AM. Methods We retrospectively analyzed medical records from pediatric patients who accessed our Pediatric Emergency Department (ED) between January 2014 and December 2020, with a clinical suspicion of AM. We reviewed clinical symptoms upon presentation, head CT and lab values (white blood cell count or WBC, C-Reactive Protein or CRP) when done, presence of complications and discharge diagnosis. A multilogistic regression model was specified to establish the role of clinical features and of CT in the diagnosis of AM based on 77 patients. Results Otalgia (OR= 5.01; 95% CI= 1.52-16.51), protrusion of the auricle (OR= 8.42; 95% CI= 1.37-51.64) and hyperemia (OR= 4.07; 95% CI= 1.09-15.23) of the mastoid were the symptoms strongly associated with a higher probability of AM. In addition to clinical features, the adjusted OR conferred by head CT was 3.09 (95% CI = 0.92-10.34). Conclusions Clinical signs were most likely predictive of AM in our sample when compared to Head CT. Most common symptoms were protrusion of the auricle, hyperemia or swelling behind the ear and otalgia.
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