Cvorovic, Ljiljana (16229375800)Ljiljana (16229375800)CvorovicDudvarski, Zoran (6504165244)Zoran (6504165244)DudvarskiRelic, Nenad (57209459323)Nenad (57209459323)RelicRadivojevic, Nemanja (57216412671)Nemanja (57216412671)RadivojevicSoldatovic, Ivan (35389846900)Ivan (35389846900)SoldatovicArsovic, Nenad (17033449500)Nenad (17033449500)Arsovic2025-06-122025-06-122023https://doi.org/10.1177/01455613231212828https://www.scopus.com/inward/record.uri?eid=2-s2.0-85177639341&doi=10.1177%2f01455613231212828&partnerID=40&md5=ed8399fc5c12e329c99c2db7b2b9e815https://remedy.med.bg.ac.rs/handle/123456789/2963Introduction: We aim to provide an overview of the clinical characteristics and treatment of pediatric acute mastoiditis (AM) and its complications in the prevaccinal pneumococcal period. Materials and methods: Retrospective case series. An analysis of pediatric patients with AM treated at a university tertiary care center from 2008 to 2018 was performed. Results: The research included 121 children, and 27.3% of them had some form of complication. The mean age at presentation of AM was 3.7 years (range = 0–18 years). The most common extracranial complication of AM was a subperiosteal abscess (n = 25, 75.8%) and the most common intracranial complication was meningoencephalitis (n = 2, 6%). The most common pathogen isolated in the complicated AM was Streptococcus pneumoniae (n = 17, 51.5%). A total of 60% of patients reported antibiotic use before hospital admission, mostly third-generation cephalosporins (37.5%). There was a statistically significant difference between age group and occurrence of complications (P =.001). Females had complications more frequently than males (P =.035). There were no statistically significant differences in levels of inflammatory parameters (C-reactive protein and leukocyte count) between patients with or without complications (P =.373 and P =.124; respectively). All patients with complications of AM were surgically treated. Mortality was 0% and all children completely recovered. Conclusion: Extracranial and intracranial complications of AM required surgical treatment and extended antibiotic therapy. Inflammation parameters did not have a predictive role in identifying children with complications of AM. Further investigations will determine whether the introduction of the mandatory pneumococcal vaccine in our country has led to a reduction in the incidence of AM and its complications. © The Author(s) 2023.acute mastoiditiscomplications of acute mastoiditisprevaccinal pneumococcal periodstreptococcus pneumoniae