Prevalence of Complications in Pediatric Acute Bacterial Rhinosinusitis in Northern Alberta

Background : Acute bacterial rhinosinusitis (ABRS) can lead to serious orbital (OC) and intracranial (IC) complications in children. In a tertiary care emergency department (ED) setting, early recognition of these complications is critical for prompt and effective management. Objective: Our objective was to assess the prevalence of orbital (OC) and intracranial (IC) complications of pediatric acute bacterial rhinosinusitis (ABRS) at presentation to a tertiary care emergency department (ED). Methods : This was a retrospective cohort study conducted over four years (2017-2021) at a tertiary care pediatric center. Eligible subjects were those under 18 with ABRS presenting to the ED. We collected demographic characteristics, treatment modalities (imaging, medical, and surgical) were collected from ConnectCare (Epic) and NARCS (National Ambulatory Care Reporting System). Our outcome measures were the prevalence of OC and IC complications, demographic characteristics, treatment modalities and surgical intervention rates of pediatric patients presenting to the ED with ABRS. Results : Of 290 identified records, 211 were reviewed, and 26 children met the diagnostic criteria for ABRS. Fifteen children (57.69%) developed complications (8 OC only, 2 IC only, and 5 both). Amongst the IC, two had subdural empyema, four had epidural empyemas, three had brain abscesses, and two had meningitis. Of the thirteen individuals with OC, three had preseptal cellulitis, nine had orbital cellulitis, five had a subperiosteal abscess, and one had an orbital abscess. The median age was eleven years for ICs and nine for OCs. Five (19%) had a previously diagnosed atopic disease, and eight (30.7%) did not resolve with prior community antibiotic treatment. Eighteen (69%) underwent imaging in the ED. Nine (34.6%) required surgical intervention. Conclusions : ABRS complications occurred in more than half of the children at the time of presentation. The results underscore the importance of earlier imaging, recognition, and management of such complications in tertiary care settings.