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{
    "pk": 15271,
    "title": "Utility of Temporal Bone Computed Tomography in Pediatric Emergency Medicine",
    "subtitle": null,
    "abstract": "Objective:\n Temporal bone computed tomography (CT) requires a relatively high radiation dose to  produce high-resolution images required to define surgical anatomy. In the acute setting, the need for  this detailed evaluation of temporal bone pathology may not be required for nonsurgical management  and clinical decision-making. We performed a retrospective review of the clinical characteristics  and subsequent management of children who underwent CT of the temporal bone with the goal of  optimizing clinical decision-making and mitigating the risks of radiation exposure in children.\nMethods:\n We included pediatric patients (<18 years of age) with International Classification of  Diseases (9th or 10th revision) diagnoses consistent with otitis externa, otitis media, mastoiditis, head  trauma, temporal bone fracture, and otalgia who were treated in the emergency department and  underwent temporal bone CT from January 1, 2012–December 31, 2016. We collected data regarding  the patients’ presenting symptoms, physical exam findings, indications for imaging, radiographic  findings, disposition, and operative intervention within 30 days of imaging. Features of the suspected  mastoiditis group were compared between operative and non-operative patients.\nResults:\n Over the four-year study period there were 96 temporal bone CTs. Most studies (70%)  were associated with a subsequent inpatient admission. Common indications for imaging included  evaluation of acute mastoiditis (55%) or trauma (41%). Of the 53 patients with concern for mastoiditis,  27 (51%) required otologic surgery. Two patients in the trauma group required surgical intervention,  both for facial nerve decompression. In patients with suspected mastoiditis, mental status changes (P =  0.02), auricular proptosis (P = 0.05), and fluctuance (P = 0.02) were significantly more prevalent in the  operative group; however, no other findings were significantly associated with operative intervention.\nConclusion:\n Temporal bone CT is beneficial in guiding diagnosis and management of acute  mastoiditis. We found that a majority of patients with suspected mastoiditis who underwent temporal  bone CT ultimately required surgery or hospital admission. However, the potential for reduction in the  use of CT still exists in this population. Fractures of the temporal bone typically do not require urgent  operative intervention in the absence of complete facial nerve paralysis; thus, the utility of temporal  bone CT in trauma evaluation may be limited.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Mastoiditis, Temporal Bone Fracture, Emergency Department, Computed Tomography, Operative"
        }
    ],
    "section": "Pediatrics",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5x75m16j",
    "frozenauthors": [
        {
            "first_name": "Sarah",
            "middle_name": "",
            "last_name": "Benyo",
            "name_suffix": "",
            "institution": "The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Darrin",
            "middle_name": "V.",
            "last_name": "Bann",
            "name_suffix": "",
            "institution": "University of North Carolina, Department of Otolaryngology – Head and Neck Surgery, Chapel Hill, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Robert",
            "middle_name": "A.",
            "last_name": "Saadi",
            "name_suffix": "",
            "institution": "University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, Little Rock, Arkansas",
            "department": "None"
        },
        {
            "first_name": "Linda",
            "middle_name": "",
            "last_name": "Gangai",
            "name_suffix": "",
            "institution": "Penn State Health Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Kathryn",
            "middle_name": "E.",
            "last_name": "Kasmire",
            "name_suffix": "",
            "institution": "Penn State Health Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Huseyin",
            "middle_name": "",
            "last_name": "Isildak",
            "name_suffix": "",
            "institution": "The Pennsylvania State University, College of Medicine, Department of Otolaryngology – Head and Neck Surgery, Hershey, Pennsylvania",
            "department": "None"
        },
        {
            "first_name": "Neerav",
            "middle_name": "",
            "last_name": "Goyal",
            "name_suffix": "",
            "institution": "The Pennsylvania State University, College of Medicine, Department of Otolaryngology – Head and Neck Surgery, Hershey, Pennsylvania",
            "department": "None"
        }
    ],
    "date_submitted": "2021-04-06T19:27:42Z",
    "date_accepted": "2021-04-06T19:27:42Z",
    "date_published": "2022-02-09T23:06:38Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/15271/galley/7747/download/"
        }
    ]
}