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Socioeconomic Disparities Affecting the Presentation and Outcomes in Pediatric Subdural Empyema Patients
Nirali Patel1, Mitchell Rock, Ehsan Dowlati
1Department of Neurosurgery, Children's National Hospital, Washington , District of Columbia , USA.
Insights
Pediatric subdural empyema (SDE) disproportionately affects African American males with public insurance, but outcomes were similar across demographics. Further research is needed to understand these disparities in SDE burden.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Public Health
Background:
- Pediatric subdural empyema (SDE) is a serious condition with high morbidity and mortality.
- Prompt diagnosis and treatment are crucial for optimal outcomes in pediatric SDE.
- Nonclinical factors may influence SDE presentation, diagnosis, and treatment timelines.
Purpose of the Study:
- To investigate the impact of socioeconomic status, race, and insurance on the presentation, diagnosis, and outcomes of pediatric subdural empyema.
- To identify potential disparities in SDE care and outcomes among different demographic groups.
Main Methods:
- Retrospective cohort study of pediatric SDE patients (2005-2020).
- Data collected on demographics (age, sex, insurance, race/ethnicity, zip code) and clinical presentation (symptoms, prior visits, symptom duration).
- Outcome measures included mortality, complications, length of stay, and discharge disposition.
Main Results:
- 42 pediatric SDE patients (mean age 9.5 years), predominantly male (85.7%) and African American (66.7%).
- African American patients experienced longer symptom duration (8.4 days vs. 1.8 days).
- No significant differences in outcomes (mortality, length of stay, discharge disposition) were observed across demographic factors, despite a higher proportion on public insurance.
Conclusions:
- While outcomes for pediatric subdural empyema were similar across nonclinical factors, African American males with public insurance face a disproportionately higher burden of SDE.
- Further investigation is warranted to understand the underlying causes of this disparity in SDE incidence.
Background And Objectives:
Pediatric subdural empyemas (SDE) carry significant morbidity and mortality, and prompt diagnosis and treatment are essential to ensure optimal outcomes. Nonclinical factors affect presentation, time to diagnosis, and outcomes in several neurosurgical conditions and are potential causes of delay in presentation and treatment for patients with SDE. To evaluate whether socioeconomic status, race, and insurance status affect presentation, time to diagnosis, and outcomes for children with subdural empyema.
Methods:
We conducted a retrospective cohort study with patients diagnosed with SDE between 2005 and 2020 at our institution. Information regarding demographics (age, sex, zip code, insurance status, race/ethnicity) and presentation (symptoms, number of prior visits, duration of symptoms) was collected. Outcome measures included mortality, postoperative complications, length of stay, and discharge disposition.
Results:
42 patients were diagnosed with SDE with a mean age of 9.5 years. Most (85.7%) (n = 36) were male ( P = .0004), and a majority, 28/42 (66.7%), were African American ( P < .0001). There was no significant difference in socioeconomic status based on zip codes, although a significantly higher number of patients were on public insurance ( P = .015). African American patients had a significantly longer duration of symptoms than their Caucasian counterparts (8.4 days vs 1.8 days P = .0316). In total, 41/42 underwent surgery for the SDE, most within 24 hours of initial neurosurgical evaluation. There were no significant differences in the average length of stay. The average length of antibiotic duration was 57.2 days and was similar for all patients. There were no significant differences in discharge disposition based on any of the factors identified with most of the patients (52.4%) being discharged to home. There was 1 mortality (2.4%).
Conclusion:
Although there were no differences in outcomes based on nonclinical factors, African American men on public insurance bear a disproportionately high burden of SDE. Further investigation into the causes of this is warranted.
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