The Absence of Fever or XXXX Does Not Exclude Infection Following Cranioplasty.

@entity1 @entity64 @entity5478 @entity281 @entity221 @entity491 @entity130
BACKGROUND: Cranioplasty encompasses various cranial reconstruction techniques that are used following craniectomy due to @entity64 or @entity130 . Despite classical infectious signs, symptoms, and radiologic findings, however, the diagnosis of @entity281 following cranioplasty can be elusive, with the potential to result in definitive treatment delay. We sought to determine if @entity221 or @entity491 at presentation were indicative of @entity281 , as well as to identify any factors that may limit its applicability. METHODS: Following institutional review board approval, a retrospective cohort of 239 @entity1 who underwent cranioplasty following craniectomy for @entity64 or @entity130 was established from 2001-2011 at a single center (Massachusetts General Hospital). Analysis was then focused on those who developed a @entity281 , as defined by either frank intra-operative purulence or positive intra-operative cultures, and subsequently underwent operative management. RESULTS: In 27 total cases of @entity281 , only two had a @entity221 and four had @entity491 at presentation. This yielded a false-negative rate for @entity221 of 92.6% and for @entity491 of 85.2%. In regard to infectious etiology, 22 (81.5%) cases generated positive intra-operative cultures, with @entity5478 being the most common organism isolated. Median interval to @entity281 was 99 days from initial cranioplasty to time of infectious presentation, and average follow-up was 3.4 years. CONCLUSIONS: The utilization of @entity221 and elevated white blood cell count in the diagnosis of post-cranioplasty @entity281 is associated with a high false-negative rate, making the absence of these features insufficient to exclude the diagnosis of @entity281 .
