Diagnosing acute mastoiditis in a Pediatric Emergency Department: a retrospective review

Chiara Bertolaso; Ignazio Cammisa; Nicola Orsini; Michela Sollazzo; Valeria Sardaro; Antonio Gatto; Antonio Chiaretti; Bruno Sergi

doi:10.23750/abm.v94i2.13839

Diagnosing acute mastoiditis in a Pediatric Emergency Department: a retrospective review

Authors

Chiara Bertolaso Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Ignazio Cammisa a:1:{s:5:"en_US";s:53:"Policlinico Universitario Fondazione Agostino Gemelli";}
Nicola Orsini Department of Global Public Health, Karolinska Institutet, Associate Professor of Medical Statistics, Head of the Biostatistics Team, Stockholm, Sweden
Michela Sollazzo Department of Otolaryngology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Valeria Sardaro Università Cattolica del Sacro Cuore, Rome, Italy.
Antonio Gatto Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Antonio Chiaretti [email protected]
Bruno Sergi Department of Otolaryngology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

DOI: https://doi.org/10.23750/abm.v94i2.13839

Keywords:

acute mastoiditis, children, emergency department, clinical signs, imaging

Abstract

Background and aim

Acute mastoiditis (AM) is a common complication of acute otitis media in children. There is currently no consensus on criteria for diagnosis. Head CT is the most frequent diagnostic tool used in the ED although the increasing awareness on the use of ionized radiations in children has questioned the use of CT imaging versus solely using clinical criteria. Our research aimed to understand if CT imaging was essential in making a diagnosis of AM.

Methods

We retrospectively analyzed medical records from pediatric patients who accessed our Pediatric Emergency Department (ED) between January 2014 and December 2020, with a clinical suspicion of AM. We reviewed clinical symptoms upon presentation, head CT and lab values (white blood cell count or WBC, C-Reactive Protein or CRP) when done, presence of complications and discharge diagnosis. A multilogistic regression model was specified to establish the role of clinical features and of CT in the diagnosis of AM based on 77 patients.

Results

Otalgia (OR= 5.01; 95% CI= 1.52-16.51), protrusion of the auricle (OR= 8.42; 95% CI= 1.37-51.64) and hyperemia (OR= 4.07; 95% CI= 1.09-15.23) of the mastoid were the symptoms strongly associated with a higher probability of AM. In addition to clinical features, the adjusted OR conferred by head CT was 3.09 (95% CI = 0.92-10.34).

Conclusions

Clinical signs were most likely predictive of AM in our sample when compared to Head CT. Most common symptoms were protrusion of the auricle, hyperemia or swelling behind the ear and otalgia.

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