(1041) Trends in Complications of Pediatric Acute Bacterial Sinusitis Before and After the COVID-19 Pandemic

Introduction: Acute bacterial sinusitis (ABS) is a common complication of viral upper respiratory infections in children that typically resolves without sequelae; however, some cases progress to orbital or intracranial complications requiring urgent intervention and may have become more frequent since the COVID-19 pandemic. This study evaluated national trends in complicated pediatric ABS using large-scale, real-world data.

Methods: A retrospective cohort study was conducted using the TriNetX United States Collaborative Network, encompassing de-identified electronic health records from multiple healthcare systems. Pediatric patients (0–18 years) diagnosed with ABS during the pre-COVID (February 2015–February 2020) and post-COVID (March 2020–March 2025) periods were identified using ICD-10 codes. Cohorts were matched for demographics. Outcomes included orbital extension, intracranial abscess, sinus surgery, and use of intravenous (IV) antibiotics. Odds ratios (OR) with 95% confidence intervals (CI) were calculated; p < 0.05 was considered significant.

Results: There were a total of 396,773 patients in the pre-COVID cohort and 330,612 in the post-COVID cohort. Compared with pre-COVID patients, post-COVID patients had higher odds of orbital cellulitis (OR 1.60, 95% CI 1.46–1.76), intracranial abscess (OR 2.00, 95% CI 1.70–2.36), and sinus surgery (OR 1.80, 95% CI 1.59–2.02). They also had greater odds of IV antibiotic administration (OR 1.25, 95% CI 1.20–1.30) and infusion use (OR 1.52, 95% CI 1.36–1.70) (p < 0.001 for all).

Conclusions: Complications of pediatric ABS may be more prevalent in the post-COVID era, suggesting heightened disease severity and need for intensive therapy. Early recognition and aggressive management remain critical to preventing morbidity.