Evolving Management of Acute Mastoiditis: Analysis of the Pediatric Health Information System Database

Objective: The optimal management of acute mastoiditis remains controversial. Most existing studies are retrospective single-institutional experiences with small cohorts. Our objectives were to analyze the treatment of acute mastoiditis by pediatric centers across the United States and changes in management over time. Study Design: Retrospective analysis. Setting: Administrative database study using Pediatric Health Information System. Methods: Patients ≤18 years of age who were admitted with a principal diagnosis of acute mastoiditis from January 1, 2010 to December 31, 2019 were included. Trends were assessed by Cochran-Armitage Trend Test. χ² and Wilcoxon rank sum tests were used to compare outcomes between the surgical and nonsurgical groups. Results: A total of 2170 patients met the inclusion criteria, with 1248 (57.5%) requiring surgical management. The rate of surgical procedures decreased significantly over time. The rate of myringotomy decreased from 64% in 2010 to 47% in 2019 (p <.001), and mastoidectomy decreased from 22% in 2010 to 10% in 2019 (p <.001). On admission, 29% of the cohort presented with mastoiditis-related complications. Patients treated surgically were younger (p <.001), more likely to present with complications (37.5% vs 17.5%, p <.001), required longer length of stay (3.7 vs 2.3 days, p <.001), and had higher intensive care unit utilization (8.6% vs 2.2%, p <.001). However, the rate of 30-day readmission, emergency department return, and in-hospital mortality were all similar. Conclusion: Acute mastoiditis has been successfully treated with declining rates of a surgery over time. Younger patients who present with complications are more likely to be managed surgically, and the overall outcomes remain excellent.