Delayed Diagnosis of Subdural Empyema in a Septic Child.

The prompt identification of sepsis in children is challenging, but once sepsis is identified, initiation of care and determination of proper disposition may be insufficient to ensure optimal outcomes. The best opportunity for full recovery also requires rapid identification and treatment of the infectious source. Acute bacterial sinusitis is common in the pediatric population, and although intracranial complications of sinusitis are rare, they are associated with significant morbidity and mortality. History and physical examination may be imperfectly sensitive for the presence of acute bacterial sinusitis and its intracranial complications. We present a case of pediatric sepsis in which the diagnosis of intracranial extension of bacterial sinusitis was not made during the first phase of care and describe complications that followed. Emergency physicians should consider subdural empyema in patients presenting with fever, nausea and headache with worrisome vital signs and laboratory values suggestive of a severe infection.