A Scoping Review of the Intracranial Complications of Pediatric Sinusitis

Introduction: Intracranial complications of pediatric sinusitis are uncommon but associated with significant morbidity when appropriate care is delayed. Risk factors associated with these complications are difficult to predict. We aim to help identify these potential risk factors.

Methods: ​​A scoping review was conducted, using standard PRISM guidelines, yielding 1230 original articles. Articles were reviewed by two independent reviewers for studies meeting inclusion criteria of pediatric populations (age < 18 years) with intracranial infection secondary to sinusitis. Consensus was reached for inclusion or exclusion by a third reviewer.

Results: Ninety-five original articles met the criteria for inclusion. Preliminary analysis has found intracranial complications of pediatric sinusitis are more frequent in African American males over the age of 5. Common presenting features are fever, headaches and forehead or facial swelling. Greater than 50% of patients reportedly were on antibiotics prior to diagnosis of an intracranial complication. Nearly all patients are diagnosed radiologically by CT scan. The most common intracranial complications are subdural and epidural empyemas. Pott’s puffy tumor and meningismus were frequently associated with intracranial complications.

Conclusions: Preliminary analysis of a scoping literature review has provided insight to possible predictive factors for intracranial complications of pediatric sinusitis. Moving forward, we plan to utilize these identified risk factors to direct a multi-institutional retrospective chart review to allow the creation of a new diagnostic tool to aid in medical and surgical decision-making for this patient population.