Hello, my name is Laquita Boswell, and I'm a MPH student in epidemiology and a research assistant at Children's of Alabama Division of Pediatric Neurosurgery. Today we will review the abstract submission, Pediatric Subdural Empyema, a 10-Year Single-Center Review. SDEs are a purulent collection of fluid located between the dura and arachnoid matter. Though they are rare, they are a time-sensitive neurosurgical emergency that has been known to arise from sinusitis, meningitis, otitis media, invasive surgical procedures, or head trauma. Once it has been identified, it must be treated immediately to avoid disability or death. The purpose of this study was to determine if the known disease profiles and time to diagnosis have evolved with modern medicine. We performed a single-institution retrospective chart review for patients seen at Children's of Alabama at Birmingham between 2010 and 2019. Forty patients were identified by utilizing the keyword search of surgical and radiological lists using the keywords subdural and empyema. Only patients who had confirmed diagnosis by either imaging reports or surgical notes were included in the study. Fourteen patients did not have a confirmed diagnosis and were excluded. This produced a cohort of 26 pediatric patients. Their ages ranged from 2 months to 17 years with a median age of 10.5 years. There were 18 males and 8 females. The cohort was approximately 62% white, 31% African American, 4% Hispanic, and 4% biracial. Our cohort of 26 is about average of the 5-6 series published in the last 20 years. FDE developed as an extension of sinusitis in 65% of cases, meningitis in 50% of cases, and 12% with a recent trauma. Smaller percentages occurred with otitis media and rarely as a result of other factors. We separated our cohort into two groups, 6 years of age and younger, and 7 years of age and older. When looking at our patients younger than 7 years of age, SDEs primarily developed from meningitis. In our 7 years of age and older, the primary cause of SDE was sinusitis at 94%. When performed, magnetic resonance imaging scans were diagnosed at 64% of the time, which in turn diagnosed 62% of the SDE cases. Assessing the entire cohort of all patients who were diagnosed with an SDE using either an imaging scan or surgical procedure, 12 were noted to have also had imaging study done within 7 days prior to the diagnostic scan. In all 12 of these patients, it was a computed tomography of the head that was performed and no SDE was reported. 21 patients required surgical intervention. 5 patients required repeat operation. All patients required aggressive antibiotic therapy. The median time from diagnosis to surgical intervention was 3.27 hours. However, this ranged from 1 hour to 5.8 days. Median time from first operation to second operation was 8.8 days with an average of 11.5 days. In conclusion, our cohort reaffirms the standard knowledge of the presentation of subdural empyemas with data that suggests younger children develop an SDE from meningitis and older children from sinusitis. Data also suggests that an MRI is more sensitive than CT when used for diagnosing an SDE. That concludes our presentation. Thank you for your time.

Pediatric Subdural Empyema

disease profiles

time to diagnosis

Magnetic resonance imaging

surgical intervention