Kavita Batra, Ph.D., M.P.H., B.D.S.
Biomedical Statistician
University of Nevada Las Vegas
Las Vegas, Nevada, United States
Disclosure information not submitted.
Mais Yacoub, MD
Clinical Assistant Professor
University Medical Center of Southern Nevada
Las Vegas, Nevada, United States
Disclosure information not submitted.
Judith Ben Ari, MD, F.A.A.P.
Clinical Assistant Professor
University Medical Center of Southern Nevada
Las Vegas, Nevada, United States
Disclosure information not submitted.
Mark Dugan, MD
Clinical Assistant Professor
UMC Children's Hospital of Nevada
Las Vegas, Nevada, United States
Disclosure information not submitted.
Title: Relationship between Pediatric Subdural Empyemas and Functional Outcomes
Introduction: Intracranial subdural empyema (SDE) is defined as a loculated collection of purulent fluid in the subdural space between the dura and the arachnoid mater. The aim of this single center case series was to report presenting features, hospital course, treatment characteristics, microbiology, surgical outcome, and Pediatric Cerebral Performance Category (PCPC) as well as Pediatric Overall Performance Category (POPC) as measures of post-hospital outcome following spontaneous SDE.
Methods: Data was collected via chart review of patients hospitalized in the Pediatric Intensive Care Unit (PICU) at UMC Children’s Hospital between 2016-2020. Descriptive statistics were used to represent characteristics of the study sample. The categorical variables were reported as frequencies and proportions. Skewed continuous variables were square root transformed for the normal approximation and then back transformed for easy interpretation. Variables collected included patient demographics, clinical characteristics, laboratory findings, culture results, treatment outcomes, and hospital course. The 95% confidence intervals for proportions and means were reported. Analysis was done with SPSS v. 26.
Results: 16 children with subdural empyema were included in the study, there was a male predominance (n=13, 81.3%) and the mean age was 11.06 years. The most common pathogen identified in culture of the SDE was strep anginosus species with n = 10 (62.5%). Average two dimensional size of abscess on CT was 9.63mm. Most patients received craniotomy (n = 10, 62.5%) or craniectomy (n = 4, 25%) in addition to endoscopic sinus surgery (10, 62.5%) and rhinosurgery (10, 62.5%). The average hospital length of stay was 16.8 days, ICU stay was 6.76 days and for those patients who were intubated, average days on a ventilator was 7.84 days. The vast majority of patients had PCPC and POPC scores of 1 at presentation (n = 15, 93.8%) and at discharge there was an increase in level of disability with 5 patients (31.2%) having a PCPC >1, and 9 patients (56.2%) with a POPC >1.
Conclusion: SDE is often associated with prolonged hospital stay, potential intubation, and decreased overall and cerebral performance categories. Improving outcomes for these children is dependent upon prompt diagnosis and initiation of antimicrobial and surgical management.