Management and Outcomes of Paediatric Intracranial Suppurations in Low- and Middle-Income Countries: A Scoping Review

Abstract

Introduction: Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs. Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included. Results: Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4-29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7-95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%. Conclusion: Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.

Keywords: infection; intracranial; low and middle income countries; management; outcomes; paediatric; suppurations.

Figure 1

PRISMA flow chart.

Figure 2

TreeMap showing the distribution of intracranial suppurations (words at the top left corner), their mean percentage (first number), lower and upper limits of the 95% confidence interval (second and third numbers, respectively). Th—Thalamic 0.2% (95% CI = 0.0 to 0.5%); BG—Basal Ganglia 0.2% (95% CI = −0.1 to 0.4%); Bs—Brainstem 0.2% (95% CI = −0.1 to 0.4%); and IV—Intraventricular 0.2% (95%CI = −0.1 to 0.4%). Unspecified corresponds to supratentorial intra-axial lesions, whose locations were not further clarified.

Figure 3

TreeMap showing causative mechanisms of intracranial suppurations (words at the top left corner), their mean percentage (first number), lower and upper limits of the 95% confidence interval (second and third numbers, respectively).