Acute Mastoiditis in Children: Is Routine Cranial Imaging on Admission Necessary to Detect Intracranial Complications?

Background: Controversy exists regarding the incorporation of routine cranial imaging on admissionto detect unapparent intracranial complications (IC) amongst children with acute mastoiditis (AM).
Objective: To study the proportion of IC amongst children diagnosed with AM, and to determine whether this complication might be anticipated upon patient’s presentation.
Methods:  Children ≤ 18 years with hospitalized AM, 2005-2012, at two centers in Israel were included. Clinical and laboratory parameters of patients with and without IC, (e.g., venous sinus thrombosis, epidural, subdural or brain abscess), diagnosed by cranial computed tomography (C-CT), were compared retrospectively.
Results: Overall, 203 children were included of whom 8 (3.9%) had IC. Streptococcus pneumoniae (26.6%), Streptococcus pyogenes(15.6%) and Pseudomonas aeruginosa (11.5%) were the most common pathogens.  There was no statistical difference between those with and without IC with respect to age, temperature on presentation, white blood cell count and c-reactive protein level, 3.4 ± 3.6 vs. 2.3 ± 2.1 years, p=0.29, 37.4 ºC± 0.8 vs. 37.8 ºC± 0.1, p=0.31, 20.7 ± 5.8 * 10 3 vs. 18.6 ± 6 * 10 3 cells/microL, p=0.31 and 128.3 ± 77.8 vs. 109.8 ± 80.8 mg/liter, p=0.43, respectively. Furthermore, there were no significant differences between the groups with respect to presence of otorrhea and the detected pathogen.  Only twoof the eight children with IC exhibited neurological signs.
Conclusions:   Most children with IC complicating AM did not exhibit any ominous clinical or laboratory findings. Further studies should explore whether routine imaging is warranted for children presenting with AM.