Intraorbital and intracranial extension of sinusitis: comparative morbidity.
OBJECTIVE
We hypothesized that intracranial extension of sinusitis carries greater morbidity than extension confined to the orbit and that presenting features can raise suspicion for intracranial extension.


METHODS
A retrospective review (1997 to 2006) identified 118 children with sinusitis complicated by intracranial extension or intraorbital extension. Presenting features and infecting organisms were compared using χ(2) or Fisher exact tests. Outcomes included duration of hospitalization, length of therapy and sequelae.


RESULTS
Thirty-three children had intracranial extension and 85 had intraorbital extension. Children with intracranial extension were older (11.4 versus 7.6 years; P ≤ .001), had more preadmission encounters (1.9 versus 1.3; P = .012), longer headache duration (9.5 versus 2.8 days; P = .009), and presented more often with vomiting (73% versus 28%; P < .001) than those with intraorbital extension. Children with intracranial extension also were hospitalized (26 versus 10 days; P < .001) and treated (36 versus 24 days; P = .001) longer. Four children (3%) had persistent sequelae.


CONCLUSIONS
Children with intracranial extension are hospitalized and treated longer than those with intraorbital extension of sinusitis but persistent sequelae are uncommon. Prolonged headache and protracted vomiting at presentation should alert caregivers to consider intracranial extension.
Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Veronica K
VK
Goytia
Carla M
CM
Giannoni
Morven S
MS
Edwards
D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D001927:Brain Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D009916:Orbital Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D017678:Sex Distribution; D012852:Sinusitis / Q000453:epidemiology* / Q000628:therapy; D013203:Staphylococcal Infections / Q000453:epidemiology; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome