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Pediatric Intracranial Infections Requiring Neurosurgery: A German Multicenter Analysis of 10-Year Trends
Daniel Dubinski1, Sae-Yeon Won1, Artem Rafaelian1
1Department of Neurosurgery, Rostock University Medical Center, Rostock , Germany.
Insights
Pediatric intracranial infections requiring neurosurgery significantly increased post-COVID-19 pandemic, particularly those linked to sinusitis and otitis. Outcomes remained similar, suggesting early intervention is key for these serious pediatric infections.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Epidemiology
Background:
- Intracranial infections in children are rare, life-threatening, and necessitate prompt neurosurgical intervention.
- The pandemic's effect on pediatric intracranial infection rates and patient outcomes remains largely uncharacterized.
Purpose of the Study:
- To investigate the incidence and outcomes of pediatric intracranial infections requiring neurosurgery before and after the COVID-19 pandemic.
- To identify potential changes in causative factors and their association with pandemic-related shifts.
Main Methods:
- A multicenter retrospective analysis was conducted on pediatric patients undergoing neurosurgery for intracranial infections (e.g., abscesses, meningitis) from January 2014 to October 2024.
- Patient data were stratified into pre-pandemic and post-pandemic cohorts for comparative analysis.
Main Results:
- The annual incidence of pediatric intracranial infections requiring neurosurgery rose significantly post-pandemic (14.4 cases) compared to pre-pandemic (5.6 cases), with an incidence risk ratio (IRR) of 2.6.
- Sinusitis-associated infections increased from 1.81 to 6.45 cases annually (IRR 3.6), and otitis-related cases surged from 0.83 to 3.95 cases annually (IRR 4.7).
- Despite increased incidence, functional outcomes (pediatric modified Rankin Scale) showed no significant difference between pre- and post-pandemic groups at discharge or 3-month follow-up.
Conclusions:
- The incidence of pediatric intracranial infections necessitating neurosurgical intervention has markedly increased following the COVID-19 pandemic.
- Complicated otitis and sinusitis were identified as significant contributing factors to the post-pandemic rise in these infections.
- While incidence increased, patient outcomes did not significantly worsen, highlighting the importance of continued neurosurgical care during and after public health crises.
Background And Objectives:
Intracranial infection in children is a rare but life-threatening condition that requires immediate neurosurgical care. The impact of the COVID-19 pandemic on incidence and outcome is unclear.
Methods:
This study is a multicenter retrospective analysis of children who underwent neurosurgical treatment of intracranial infections (epidural abscess, subdural empyema, cerebral abscess, ventriculitis, and meningitis) between January 2014 and October 2024. Comparison of children with intracranial infections and neurosurgical intervention stratified by pre and postpandemic.
Results:
The annual incidence of pediatric intracranial infections requiring neurosurgery increased significantly from 5.6 cases (95% CI: 4.0-7.5) prepandemic to 14.4 cases (95% CI: 11.2-18.0) postpandemic, with an incidence risk ratio (IRR) of 2.6 (95% CI: 1.8-3.8; P < .0001). Causative were the observed sinusitis-associated cases, with absolute numbers rising from 13 prepandemic to 31 postpandemic. The annual incidence increased from 1.81 cases (95% CI: 0.99-2.97) to 6.45 cases (95% CI: 4.44-9.00), yielding an IRR of 3.6 (95% CI: 1.9-7.1; P = .0001). For otitis-related cases, absolute counts surged from 6 to 19, accompanied by an incidence increase from 0.83 (95% CI: 0.33-1.69) to 3.95 (95% CI: 2.43-6.01), with an IRR of 4.7 (95% CI: 2.0-13.0; P = .0009). However, functional outcomes assessed by the pediatric modified Rankin Scale showed no statistically significant differences between pre- and postpandemic cohorts in the Wilcoxon-Mann-Whitney test, both at discharge ( P = .388) and at 3-month follow-up ( P = .927).
Conclusion:
Our study demonstrates a significant increase in the incidence of intracranial infections requiring neurosurgical treatment in children after the pandemic, with a 2.4-fold higher IRR compared with the prepandemic period. The postpandemic group had a significantly higher incidence of underlying complicated otitis and sinusitis.
