The Absence of Fever or Leukocytosis Does Not Exclude Infection Following Cranioplasty

Fady Girgis, Brian P. Walcott, Churl Su Kwon, Sameer A. Sheth, Wael Asaad, Brian V. Nahed, Emad N. Eskandar, Jean Valery Coumans

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: Cranioplasty encompasses various cranial reconstruction techniques that are used following craniectomy due to stroke or trauma. Despite classical infectious signs, symptoms, and radiologic findings, however, the diagnosis of infection following cranioplasty can be elusive, with the potential to result in definitive treatment delay. We sought to determine if fever or leukocytosis at presentation were indicative of infection, as well as to identify any factors that may limit its applicability.

METHODS: Following institutional review board approval, a retrospective cohort of 239 patients who underwent cranioplasty following craniectomy for stroke or trauma was established from 2001-2011 at a single center (Massachusetts General Hospital). Analysis was then focused on those who developed a surgical site infection, as defined by either frank intra-operative purulence or positive intra-operative cultures, and subsequently underwent operative management.

RESULTS: In 27 total cases of surgical site infection, only two had a fever and four had leukocytosis at presentation. This yielded a false-negative rate for fever of 92.6% and for leukocytosis of 85.2%. In regard to infectious etiology, 22 (81.5%) cases generated positive intra-operative cultures, with Propionibacterium acnes being the most common organism isolated. Median interval to infection was 99 days from initial cranioplasty to time of infectious presentation, and average follow-up was 3.4 years.

CONCLUSIONS: The utilization of fever and elevated white blood cell count in the diagnosis of post-cranioplasty infection is associated with a high false-negative rate, making the absence of these features insufficient to exclude the diagnosis of infection.

Original languageEnglish (US)
Pages (from-to)255-259
Number of pages5
JournalThe Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
Volume42
Issue number4
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

Fingerprint

Leukocytosis
Fever
Surgical Wound Infection
Infection
Stroke
Propionibacterium acnes
Research Ethics Committees
Wounds and Injuries
Leukocyte Count
General Hospitals
Signs and Symptoms

Keywords

  • complication
  • craniofacial surgery
  • cranioplasty
  • infections of the nervous system
  • trauma

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

The Absence of Fever or Leukocytosis Does Not Exclude Infection Following Cranioplasty. / Girgis, Fady; Walcott, Brian P.; Kwon, Churl Su; Sheth, Sameer A.; Asaad, Wael; Nahed, Brian V.; Eskandar, Emad N.; Coumans, Jean Valery.

In: The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, Vol. 42, No. 4, 01.07.2015, p. 255-259.

Research output: Contribution to journalArticle

Girgis, Fady ; Walcott, Brian P. ; Kwon, Churl Su ; Sheth, Sameer A. ; Asaad, Wael ; Nahed, Brian V. ; Eskandar, Emad N. ; Coumans, Jean Valery. / The Absence of Fever or Leukocytosis Does Not Exclude Infection Following Cranioplasty. In: The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. 2015 ; Vol. 42, No. 4. pp. 255-259.
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AU - Kwon, Churl Su

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AU - Asaad, Wael

AU - Nahed, Brian V.

AU - Eskandar, Emad N.

AU - Coumans, Jean Valery

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N2 - BACKGROUND: Cranioplasty encompasses various cranial reconstruction techniques that are used following craniectomy due to stroke or trauma. Despite classical infectious signs, symptoms, and radiologic findings, however, the diagnosis of infection following cranioplasty can be elusive, with the potential to result in definitive treatment delay. We sought to determine if fever or leukocytosis at presentation were indicative of infection, as well as to identify any factors that may limit its applicability.METHODS: Following institutional review board approval, a retrospective cohort of 239 patients who underwent cranioplasty following craniectomy for stroke or trauma was established from 2001-2011 at a single center (Massachusetts General Hospital). Analysis was then focused on those who developed a surgical site infection, as defined by either frank intra-operative purulence or positive intra-operative cultures, and subsequently underwent operative management.RESULTS: In 27 total cases of surgical site infection, only two had a fever and four had leukocytosis at presentation. This yielded a false-negative rate for fever of 92.6% and for leukocytosis of 85.2%. In regard to infectious etiology, 22 (81.5%) cases generated positive intra-operative cultures, with Propionibacterium acnes being the most common organism isolated. Median interval to infection was 99 days from initial cranioplasty to time of infectious presentation, and average follow-up was 3.4 years.CONCLUSIONS: The utilization of fever and elevated white blood cell count in the diagnosis of post-cranioplasty infection is associated with a high false-negative rate, making the absence of these features insufficient to exclude the diagnosis of infection.

AB - BACKGROUND: Cranioplasty encompasses various cranial reconstruction techniques that are used following craniectomy due to stroke or trauma. Despite classical infectious signs, symptoms, and radiologic findings, however, the diagnosis of infection following cranioplasty can be elusive, with the potential to result in definitive treatment delay. We sought to determine if fever or leukocytosis at presentation were indicative of infection, as well as to identify any factors that may limit its applicability.METHODS: Following institutional review board approval, a retrospective cohort of 239 patients who underwent cranioplasty following craniectomy for stroke or trauma was established from 2001-2011 at a single center (Massachusetts General Hospital). Analysis was then focused on those who developed a surgical site infection, as defined by either frank intra-operative purulence or positive intra-operative cultures, and subsequently underwent operative management.RESULTS: In 27 total cases of surgical site infection, only two had a fever and four had leukocytosis at presentation. This yielded a false-negative rate for fever of 92.6% and for leukocytosis of 85.2%. In regard to infectious etiology, 22 (81.5%) cases generated positive intra-operative cultures, with Propionibacterium acnes being the most common organism isolated. Median interval to infection was 99 days from initial cranioplasty to time of infectious presentation, and average follow-up was 3.4 years.CONCLUSIONS: The utilization of fever and elevated white blood cell count in the diagnosis of post-cranioplasty infection is associated with a high false-negative rate, making the absence of these features insufficient to exclude the diagnosis of infection.

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