Resident MedStar Georgetown University Hospital Washington, District of Columbia, United States
Disclosure(s):
Nirali Patel, MD: No financial relationships to disclose
Introduction: Pediatric subdural empyemas (SDE) carry significant morbidity and mortality and often present with nonspecific symptoms. Nonclinical factors have been shown to affect presentation and outcomes of several neurosurgical conditions but have not been studied in patients with SDE. To evaluate whether socioeconomic status (SES), race, and insurance status affect presentation, time-to-diagnosis, and outcomes for children with SDE.
Methods: Information regarding demographics (age, sex, zip code, insurance status, race/ethnicity) and presentation (vital signs, symptoms, number of prior visits, duration of symptoms, etc.) was retrospectively collected for patients at Children’s National Hospital diagnosed with SDE. Outcome measures included mortality, number of surgeries, discharge disposition, and length of stay (LOS).
Results: Between 2005 and 2020, 43 patients with SDE were identified. Average age was 9.92 years. 86% of the patients (n=37) were male (p < 0.001) and 29/43 (70.7%) were African American (p < 0.0001). There was no significant difference in SES of patients, though there was a significantly high number of patients on public insurance (p=0.0013). Most of the patients had at least 2 visits to a health care provider for the presenting symptoms. African American patients had a significantly longer duration of symptoms than their Caucasian counterparts (8.3days vs 1.8days p=0.03). 41/43 underwent surgery, with an average of 1.69 surgeries per patient. There were no significant differences in the average LOS, which was 11.1 days for the PICU and 24.9 days overall. The average length of antibiotic duration was similar for all patients (56.8days). There were no significant differences in discharge disposition with 22 /43 (51.2%) being discharged home and 17/43 (39.5%) being discharged to rehabilitation facilities. There was one mortality (2.3%).
Conclusion : Though there were no differences in outcomes, African American males on public insurance bear a disproportionately high burden of SDE. Further investigation into the causes of this is warranted.
