RESUMO
BACKGROUND: Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY: Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS: A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, pâ¯<â¯0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], pâ¯<â¯0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, pâ¯<â¯0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], pâ¯<â¯0.001) but similar LOS (12 [10] v 11 [9] days, pâ¯=â¯0.783). CONCLUSIONS: Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.
Assuntos
Doenças do Sistema Nervoso Central/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Doenças Orbitárias/economia , Rinite/complicações , Sinusite/complicações , Doença Aguda , Adolescente , Abscesso Encefálico/economia , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/cirurgia , Criança , Bases de Dados Factuais , Feminino , Humanos , Masculino , Meningite/economia , Meningite/etiologia , Meningite/cirurgia , Procedimentos Neurocirúrgicos/economia , Doenças Orbitárias/etiologia , Doenças Orbitárias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Trombose dos Seios Intracranianos/economia , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/cirurgiaRESUMO
OBJECTIVE: Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications. STUDY DESIGN: Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. SETTING: Emergency Department. PATIENTS: Patients who presented with a primary diagnosis of AOM or acute mastoiditis. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted. RESULTS: A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (pâ<â0.0001, for all comparisons). CONCLUSIONS: ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.
Assuntos
Abscesso Encefálico/etiologia , Paralisia Facial/etiologia , Hospitalização , Labirintite/etiologia , Mastoidite/etiologia , Meningite/etiologia , Otite Média/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Medicare , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: Review costs for pediatric patients with complicated acute sinusitis. METHODS: A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. RESULTS: The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. CONCLUSION: Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients.
Assuntos
Abscesso Encefálico/economia , Abscesso Epidural/economia , Custos Hospitalares , Hospitais Pediátricos/economia , Celulite Orbitária/economia , Sinusite/economia , Doença Aguda , Adolescente , Abscesso Encefálico/etiologia , Trombose do Corpo Cavernoso/economia , Trombose do Corpo Cavernoso/etiologia , Criança , Pré-Escolar , Custos de Medicamentos , Abscesso Epidural/etiologia , Humanos , Unidades de Terapia Intensiva Pediátrica/economia , Tempo de Internação/economia , Salas Cirúrgicas/economia , Celulite Orbitária/etiologia , Quartos de Pacientes/economia , Tumor de Pott/economia , Tumor de Pott/etiologia , Estudos Retrospectivos , Sinusite/complicaçõesRESUMO
An analysis of demographic and epidemiologic situation was made in cases of otogenic and rhinosinusogenic intracranial complications on the area of 32 regions of Russian Federation at the period from 2009 to 2014. The state of ENT-service of examined subject is characterized by reduction of provision of during ENT-beds and lower level of hospitalization of population over indicated period. There was revealed a reliable correlated dependence of the main medical statistical indices from the intracranial complications with climatic and demographic factors, the rate of morbidity and activities of ENT-service in the area of this region.
Assuntos
Abscesso Encefálico , Otopatias , Doenças dos Seios Paranasais , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/etiologia , Demografia , Otopatias/complicações , Otopatias/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Neurocirurgia/métodos , Neurocirurgia/estatística & dados numéricos , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Doenças dos Seios Paranasais/complicações , Doenças dos Seios Paranasais/epidemiologia , Federação Russa/epidemiologiaRESUMO
A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.
Assuntos
Antibacterianos/uso terapêutico , Abscesso Encefálico/cirurgia , Craniotomia , Meningoencefalite/cirurgia , Otite Média Supurativa , Procedimentos Cirúrgicos Otológicos , Adulto , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/etiologia , Doença Crônica , Terapia Combinada , Craniotomia/efeitos adversos , Craniotomia/métodos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/epidemiologia , Meningoencefalite/etiologia , Testes de Sensibilidade Microbiana , Neuronavegação/métodos , Otite Média Supurativa/complicações , Otite Média Supurativa/diagnóstico , Otite Média Supurativa/epidemiologia , Otite Média Supurativa/microbiologia , Otite Média Supurativa/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/métodos , Federação Russa/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVES/HYPOTHESIS: To identify characteristics and disparities associated with presentation of pediatric acute bacterial sinusitis (ABS) complications. STUDY DESIGN: A cross-sectional study of the 2008 Nationwide Emergency Department Sample database. METHODS: A total of 101,660 children 18 years of age or younger diagnosed with ABS, 696 of whom had orbital or intracranial complications, were identified. Patient and hospital-specific characteristics were investigated for association with childhood ABS complications. RESULTS: Orbital and intracranial complications occurred in 0.7% of children with ABS. Such complications were more common in boys (odds ratio [OR]: 1.65, P<.001) and children with chronic rhinosinusitis (OR: 7.89, P<.001), and were associated with presentation to metropolitan teaching (OR: 2.15, P<.001) and nonteaching (OR: 14.39, P<.001) hospitals. Orbital complications were associated with younger age (OR: 0.96, P<.001), whereas intracranial complications were associated with older age (OR: 1.11, P<.001). A dichotomy in socioeconomic background differentiated children with orbital ABS complications from those with intracranial complications. Although orbital complications were associated with higher income (OR: 2.13, P<.001) and private insurance (OR: 1.36, P=.003), intracranial complications were associated with Medicaid (OR: 2.96, P<.001) or no insurance at all (OR: 3.73, P=.001). CONCLUSIONS: Socioeconomic disparities exist in presentation of ABS complications in children. Although hinted at by the association with urban/metropolitan hospitals, explicit evidence is provided by association of intracranial complications with markers of low socioeconomic status and poor access to healthcare. Efforts to aid early diagnosis and treatment should target providers in metropolitan areas who treat children of lower socioeconomic status. Such interventions will ideally improve outcomes and limit healthcare costs related to the high morbidity of pediatric ABS complications. LEVEL OF EVIDENCE: 2b.
Assuntos
Abscesso Encefálico/etiologia , Celulite Orbitária/etiologia , Sinusite/complicações , Doença Aguda , Adolescente , Abscesso Encefálico/economia , Abscesso Encefálico/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Celulite Orbitária/economia , Celulite Orbitária/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Sinusite/microbiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologiaAssuntos
Infecção Focal Dentária/complicações , Abscesso Encefálico/etiologia , Causas de Morte , Criança , Assistência Odontológica para Crianças/economia , Assistência Odontológica para Crianças/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Choque Séptico/etiologia , Estados UnidosRESUMO
Clinical cases and 245 case reports have been analyzed in terms of otogenic intracranial complications. Of late, there is a trend to lowering occurrence of otogenic complications and lethal outcomes compared to 1950-60. More favourable outcomes are attributed to introduction of new antibiotics and higher quality of ENT service.
Assuntos
Abscesso Encefálico/epidemiologia , Abscesso Encefálico/etiologia , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/etiologia , Otite Média Supurativa/complicações , Trombose dos Seios Intracranianos/epidemiologia , Trombose dos Seios Intracranianos/etiologia , Doença Aguda , Adolescente , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Meningite Meningocócica/tratamento farmacológico , Pessoa de Meia-Idade , Federação Russa/epidemiologia , Trombose dos Seios Intracranianos/tratamento farmacológicoRESUMO
The authors report a prospective study of morbidity associated with long-term seizure monitoring using subdural strip electrodes. Three hundred fifty patients were divided into two groups: 175 patients received antibiotics intravenously during the entire period that the electrodes were implanted, and 175 patients received one dose of antibiotics on the morning of surgery. In the group given continuous antibiotic coverage there were two cases of meningitis, both treated without sequelae. In the group receiving one dose of antibiotics, one patient had a brain abscess and three had superficial wound infections. There were no other instances of major morbidity or mortality in either group of patients. The total morbidity rate for both serious and minor complications was 0.85%.
Assuntos
Antibacterianos/administração & dosagem , Eletrodos Implantados , Eletroencefalografia/instrumentação , Epilepsia/diagnóstico , Meningite/etiologia , Meningite/prevenção & controle , Espaço Subdural , Adulto , Abscesso Encefálico/etiologia , Análise Custo-Benefício , Eletrodos Implantados/economia , Eletroencefalografia/efeitos adversos , Epilepsia/fisiopatologia , Epilepsia/cirurgia , Feminino , Humanos , Masculino , Estudos Prospectivos , Infecção dos Ferimentos/etiologiaRESUMO
Computed tomographic (CT) scans of ten patients with rhinocerebral mucormycosis were reviewed. Early paranasal sinus involvement appeared as mucosal thickening on CT scans, usually without air/fluid levels. Recognition as mucormycosis was facilitated by knowledge of the clinical setting or by identification of invasive disease. Evidence of bone destruction on CT scans was seen in only two patients, was a late finding, and usually was absent despite deep extension of disease beyond the bony confines of the paranasal sinus. Five cases had intracranial involvement, either as fungal abscess or infarction. Intracranial mucormycosis usually involved the base of the brain and cerebellum following invasion of the infratemporal fossa or orbit. Intracerebral fungal abscess appeared as low-density masses on CT scans, with variable peripheral enhancement and little surrounding vasogenic edema. Identification of a rim of spared cortex was useful in distinguishing infection from bland infarct. Serial CT scans were also useful in assessing response to hyperbaric oxygen treatment, surgery, and chemotherapy.