Changing epidemiology and increasing healthcare burden of pediatric brain abscess in China: a nationwide study before and after COVID-19

Purpose Pediatric brain abscess (BA) is a rare but life-threatening condition, and large-scale epidemiological studies are limited, especially concerning the changes after the coronavirus disease 2019 (COVID-19) pandemic. We aimed to describe nationwide temporal trends in pediatric BA in China and to assess changes in predisposing factors and healthcare burden before and after the COVID-19 pandemic. Methods We conducted a nationwide study using the FuTang Update Medical Records (FUTURE) database, which includes face sheet of discharge medical records data from 33 tertiary children’s hospitals across China. Case-identification strategies were validated and the optimal strategy was applied to identify BA cases. Demographic information, predisposing factors, complications, and clinical outcomes of included cases were collected and analyzed. Results A total of 873 patients were identified, with 7.1 to 8.8 per 100,000 hospitalized children annually (P=0.789). After 2020, the proportion of patients aged 0 and 1-3 years decreased, while the proportion of patients aged 10-12 years and 13-17 years increased (all P<0.05). Among predisposing factors, meningitis decreased from 18.7% (2016-2019) to 12.7% (2020-2023) (P=0.016), contiguous infections increased from 9.1% to 15.6% (P=0.004), and congenital heart disease remains stable. In the post-COVID-19 era, the proportions of neurological surgery, intracranial complications, systemic complications, longer lengths of stay, and hospitalization all increased (all P<0.05). Conclusion Although the proportion of BA among hospitalized children in China was stable, the distribution of predisposing factors age has changed and the healthcare burden increased after the COVID-19 pandemic.