Introduction: There is limited data on the burden of intracranial abscesses (ICA). We sought to quantify the inpatient burden, neurosurgical management and outcome of ICA in the United States.
Methods: The 2001-2010 Nationwide Inpatient Sample was queried and appropriate ICD-9CM diagnostic and procedure codes identified patients with ICA diagnosis (324.0), patients that underwent craniotomy surgery [drainage of epidural-01.24, and/or subdural-01.31 abscesses], and ventriculostomy/shunting procedures (0.22; 02.31-02.39). Descriptive analysis and multivariate logistic regression examined outcomes. Data were weighted to the US national population.
Results: A total of 55,535 ICA inpatient admissions were identified. Age distribution was bimodal (See attached figure); overall mean age was 46.8 years [Standard Error/SE=0.20]. Most patients were male (65.4%), race was distributed as follows: whites (50.8%), blacks (11.5%), Hispanics (9.3%), other/unknown (28.4%).
In all, 20.1% of patients had surgery. Average time-to-surgery was 3.18 days (SE=0.13). Ventriculostomy/shunting was performed in 8.4% of patients and in 11.3% that underwent surgery; intracranial pressure monitors placement in 0.4% overall, and in 0.8% that had surgery, p<0.001; while mechanical ventilation was indicated in 14.5% of patients, and in 17.8% that had surgery, p<0.001. Patients that had surgery [Odds-ratios/OR=1.37; 95%Confidence-interval/CI=1.14-1.64)] and </=18year-olds (OR1.86; 95%CI=1.28-2.70) were more likely for ventriculostomy/shunting. Mechanical ventilation was more likely in >/=65year-olds (OR1.11; 95%CI=1.02-1.20), persons undergoing surgery (OR1.22; 95%CI=1.05-1.45), and ventriculostomy/shunting (OR4.42; 95%CI=3.74-5.22).
Overall inpatient mortality was 6.5%, and was lower in surgery vs non-surgery patients (4.5% vs. 7.0%, p<0.001). Most survivors were discharged to intermediate/long-term care (40.0%), routine/homecare (28.5%), and hospice-care (25.0%), p<0.001. Factors significantly associated with inpatient mortality were: >/=65year-olds (OR3.8; 95%CI=2.4-6.1), Hispanics (OR2.36; 95%CI=1.53-3.64), ventriculostomy/shunting (OR1.93; 95%CI=1.46-2.54), surgery (OR0.47; 95%CI=0.35-0.61), and time-to-surgery of </=48hours (OR0.79; 95%CI=0.65-0.98). Average length of hospitalization was 16.5 days (SE=0.18). Annual total charges averaged $610,786,703.
Conclusions: Intracranial abscesses constitute a significant morbidity burden among infants and older adults. Early neurosurgical drainage is associated with improved survival.
Patient Care: This research will help to improve care of patients by reporting current neurosurgical treatment and practice patterns in the care and management of intracranial abscesses. Through evaluating outcomes of patients receiving care, it will also help to provide a benchmark for further improvement of current standards.
Learning Objectives: 1. To desribe the burden of Intracranial abscesses in the United States and identify those who are at greater risk
2. To evaluate management paratices and outcomes of patients with intracranial abscesses.