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. 2024 Dec;281(12):6405-6413.
doi: 10.1007/s00405-024-08894-5. Epub 2024 Aug 22.

Subperiosteal abscess volume; an objective indication for surgical management in pediatrics

Luluh Alsughayer  1   2 , Abdullah Sindi  3   4   5 , Mohammed AlQuwayee  6 , Ahmed Alhussien  3 , Latifah Makoshi  3 , Abdulmajeed Zakzouk  3   5
Affiliations

Subperiosteal abscess volume; an objective indication for surgical management in pediatrics

Luluh Alsughayer et al. Eur Arch Otorhinolaryngol. 2024 Dec.

Abstract

Purpose: Subperiosteal abscess (SPA) can lead to devastating morbidity and mortality. Prompt management is important; however, the choice of management route is controversial. This study investigates factors associated with surgical management and defines a cut-off abscess volume prompting surgical intervention.

Methods: SPA cases presented to King Saud University Medical City (KSUMC) from 2014 to 2023 were reviewed. The surgical approach was studied in association with factors including age, gender, symptoms and signs, laboratory results, computed tomography (CT) characteristics, medications, and surgical approach. Multiple statistical tests were used for analysis, including student t-test, chi-square, multiple logistic regression analysis, and receiver operating characteristic (ROC) analysis.

Results: Patients were managed medically (n = 14, 45.16%) or surgically (n = 17, 54.84%). The average duration of antibiotics was 15 days. Superior SPA favors surgical management (OR = 6.722, CI [1.332-33.913], p = 0.029), along with the use of steroids (OR = 5.625, CI [0.915-34.572], p = 0.049), and abscess volume (OR = 10.003, CI [1.418-70.540], p < 0.001). However, the only factor attributing to a surgical decision on multivariate logistic regression analysis was abscess volume (OR = 5.126, CI [1.023-25.694], p = 0.047). SPA volume of ≥ 0.648 ml strongly prompts surgical management, with a sensitivity of 94.1% and a specificity of 71.4% (p = 0.000).

Conclusion: SPA volume increases the likelihood of surgical intervention by five times, especially when abscess volume is ≥ 0.648 ml.

Keywords: Abscess volume; Complicated sinusitis; Orbital cellulitis; Subperiosteal abscess.

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Conflict of interest statement

Declarations Competing interests The authors have no competing interest to declare.

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