← Back to Previous Page

 

P103: EXPLORING DEMOGRAPHIC CHARACTERISTICS AND CLINICAL MANIFESTATIONS OF SKULL BASE OSTEOMYELITIS: A COMPARATIVE ANALYSIS OF TWO ACADEMIC HOSPITAL SYSTEMS
Shreya Jain, BA¹; Marco A Campioli, BA¹; Kaitlyn A Brooks, MD²; Angela Peng, MD²; ¹School of Medicine, Baylor College of Medicine, Houston, TX, USA; ²Bobby R Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA

Background: Skull base osteomyelitis (SBO) is a rare, life-threatening infection with significant potential co-morbidities. Because of our experience managing SBO among a diverse patient population, we aimed to evaluate how clinical and demographic characteristics impact risk of SBO diagnosis between different healthcare settings.

Methods: A retrospective case-control study was performed with aggregate patient electronic health data from 2000-2025 at two urban healthcare institutions: a private academic center (Institution-A) and a public, safety-net hospital (Institution-B). Adult patients with SBO were identified through ICD coding and compared against adults without SBO ICD codes. Odds ratios evaluated the effect size of SBO diagnosis and association among demographics, co-morbidities, and symptomatology. 

Results: Institution-A had 351 cases and 4,309,144 controls. Institution-B had 539 cases and 4,067,562 controls. The odds of SBO diagnosis were significantly higher at Institution-B vs. Institution-A (OR 1.63, 95% CI 1.42-1.86). 

Otologic symptoms and/or otitis media were strong predictors of an SBO diagnosis across both institutions (Tables 1-2). Female patients, patients with BMI ≥ 30 kg/m², and patients of Hispanic/Latino ethnicity had significantly increased odds of diagnosis (Table 3). Institution-B, however, demonstrated a significantly stronger association for Hispanic/Latino ethnicity and history of MI, atrial fibrillation, and hyperlipidemia compared to Institution-A. Payor mix varied between institutions (Figure 1).

Table 1: Co-morbidities associated with SBO diagnosis

	Institution-A	Institution-B
T2DM	17.97***[14.56-22.16]	18.73***[15.81-22.18]
CKD	10.00***[7.41-13.25]	14.30***[11.35-17.82]
Hypertension	10.89***[8.83-13.44]	14.12***[11.87-16.82]
Stroke	5.61***[2.79-9.95]	9.70***[6.52-13.83]
MI	3.63***[1.80-6.43]	9.79***[7.63-12.38]
Atrial Fibrillation	3.16***[1.80-5.10]	6.38***[3.84-9.89]
Otitis Media	79.03***[63.78-97.67]	75.02***[63.35-88.87]
HIV	7.48***[3.97-12.69]	6.84***[4.33-10.21]
Hyperlipidemia	11.28***[9.13-13.92]	19.47***[16.34-23.26]

 

 

 

 

 

 

 

 

 

Table 2: Symptomatology associated with SBO diagnosis

	Institution-A	Institutition-B
Hearing Loss	30.15***[23.99-37.66]	46.82***[39.19-55.77]
Dizziness	13.72***[10.71-17.40]	16.43***[13.71-19.61]
Otorrhea	214.18***[158.36-284.16]	211.52***[167.68-263.94]
Otalgia	98.40***[79.45-121.58]	109.58***[92.42-130.09]
Facial Nerve Disorders	24.56***[14.26-39.18]	23.63***[16.20-33.20]

 

 

 

 

 

 

Table 3: Demographics associated with SBO diagnosis

	Institution-A	Institution-B
BMI ≥30 vs. BMI ≥18.5 to <25	2.14*[1.37-3.44]	1.47***[1.24-1.74]
BMI ≥30 vs. BMI ≥25 to <30	1.71 [1.13-2.62]	1.17 [1.01-1.35]
Female vs. Male	1.47**[1.19-1.81]	1.53***[1.29-1.82]
Hispanic/Latino	2.72***[1.93-3.82]	7.52***[6.24-9.10]

 

 

 

 

 

 

 

 

*p<0.01; **p<0.001; ***p<0.0001

Conclusions: Healthcare setting, otologic symptoms, and chronic co-morbidities are strongly associated with developing SBO. Our results indicate that patients who seek care at safety-net hospitals with chronic health conditions have increased odds of SBO diagnosis compared to similar patients who seek care at private academic institutions. These findings may be explained by decreased access to consistent management of co-morbid conditions and require further investigation. 

View Poster

 

← Back to Previous Page