(1041) Intracranial Complications in Pediatric Acute Sinusitis: A Multicenter Population-Based Study

Introduction: Acute sinusitis is a common pediatric diagnosis, typically managed conservatively. Intracranial infection, while rare, poses substantial risks. This study compares demographics, comorbidities, and treatments in pediatric acute sinusitis patients with and without intracranial complications.

Methods: A retrospective study was conducted in the TriNetX database. Queries targeted patients aged 17 years or younger with a first-time diagnosis of acute sinusitis, with or without intracranial infection 3 months post-diagnosis. Demographics, comorbidities, and treatments were extracted using relevant ICD-10 codes.

Results: 364,809 children with acute sinusitis were identified; 125 (0.03%) had intracranial complications. Of those, comorbidities included meningitis (n = 67, 53.6%), intracranial abscess or granuloma (n = 62, 49.6%), encephalitis, myelitis or encephalomyelitis (n = 19, 15.2%), and intracranial phlebitis or thrombophlebitis (n = 19, 15.2%). Children with intracranial complications were older (mean age = 7 years, SD = 4.08) than those without (mean age = 5.27 years, SD = 4.15), more likely to be Black or African American, and had a higher incidence of congenital deformities (p < 0.001). Children with intracranial complications were more likely to undergo endoscopic procedures on the accessory sinuses (n = 22, 17.6%, p< 0.001), including sinusotomies (n = 10, 8%, p < 0.001) and craniectomies (n = 10, 8%, p < 0.001) at the time of diagnosis. Pre-diagnosis antibiotics differed, with less use of penicillin and beta-lactam antimicrobials, but higher usage of vancomycin, metronidazole, polymyxin B, and bacitracin (p < 0.001).

Conclusions: Intracranial complications are rare in the context of acute sinusitis. Surgical intervention in these cases also appears to be uncommon, suggesting that antibiotic therapy is typically successful.