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Review Article
Online Published: 21 Oct 2025
 


Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review

Yahia Abdelgawad Elsayed Elboraei, Dala Saad Alanazi, Nouf Sami Alanazi, Layali Khaled Alruwaili, Shahad Mohamed Alanazi, Shahad Abdulaziz Almohileb, Jood Ghazi Alanazi, Joud M. Alkhidhr.


Abstract
Acute mastoiditis (AM) is the most serious complication of acute otitis media (AOM). Variation persists in how clinical signs, radiologic imaging, and routine laboratory markers are used at first presentation. This study aimed to evaluate the diagnostic accuracy and clinical utility of bedside examination, computed tomography/ magnetic resonance imaging (CT/MRI), and inflammatory markers for identifying AM and its complications. A systematic review was conducted following PRISMA 2020 guidelines. Eligible observational studies and reviews enrolling children and/or adults with suspected AM and reporting accurate data or clinically anchored outcomes were included. Data were abstracted for predefined clinical signs, imaging features, laboratory values, and reference standards; heterogeneity precluded meta-analysis, and findings were synthesized narratively. Classic post-auricular features in the context of AOM (erythema/swelling, tenderness or fluctuance, auricular proptosis) were the most reliable first-line indicators and were present in nearly all pediatric AM. Radiology reports of “mastoiditis” based on mastoid opacification alone showed poor positive predictive value; coalescent change (bony septal/cortical erosion) and sub-periosteal collections correlated best with clinically confirmed AM. MRI was highly sensitive for excluding intracranial extension but less specific for bony disease; CT remained the preferred test to confirm coalescence when red flags were present. Leukocytosis and elevated C-reactive protein were common and associated with severity, yet neither reliably confirmed nor excluded AM at presentation. Across cohorts, most uncomplicated pediatric cases were successfully diagnosed and managed without routine upfront imaging. Standardized, prospectively validated diagnostic pathways are needed to reduce overdiagnosis from incidental mastoid opacification while safeguarding against missed complications.

Key words: Acute mastoiditis, clinical diagnosis, emergency setting, diagnostic accuracy, systematic review


 
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Pubmed Style

Elboraei YAE, Alanazi DS, Alanazi NS, Alruwaili LK, Alanazi SM, Almohileb SA, Alanazi JG, Alkhidhr JM. Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review. IJMDC. Online First: 21 Oct, 2025. doi:10.24911/IJMDC.51-1757828347

Web Style

Elboraei YAE, Alanazi DS, Alanazi NS, Alruwaili LK, Alanazi SM, Almohileb SA, Alanazi JG, Alkhidhr JM. Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review. https://www.ijmdc.com/?mno=283689 [Access: October 22, 2025]. doi:10.24911/IJMDC.51-1757828347

AMA (American Medical Association) Style

Elboraei YAE, Alanazi DS, Alanazi NS, Alruwaili LK, Alanazi SM, Almohileb SA, Alanazi JG, Alkhidhr JM. Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review. IJMDC. Online First: 21 Oct, 2025. doi:10.24911/IJMDC.51-1757828347


Vancouver/ICMJE Style

Elboraei YAE, Alanazi DS, Alanazi NS, Alruwaili LK, Alanazi SM, Almohileb SA, Alanazi JG, Alkhidhr JM. Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review. IJMDC, [cited October 22, 2025]; Online First: 21 Oct, 2025. doi:10.24911/IJMDC.51-1757828347


Harvard Style

Elboraei, Y. A. E., Alanazi, . D. S., Alanazi, . N. S., Alruwaili, . L. K., Alanazi, . S. M., Almohileb, . S. A., Alanazi, . J. G. & Alkhidhr, . J. M. (2025) Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review. IJMDC, Online First: 21 Oct, 2025. doi:10.24911/IJMDC.51-1757828347


Turabian Style

Elboraei, Yahia Abdelgawad Elsayed, Dala Saad Alanazi, Nouf Sami Alanazi, Layali Khaled Alruwaili, Shahad Mohamed Alanazi, Shahad Abdulaziz Almohileb, Jood Ghazi Alanazi, and Joud M. Alkhidhr. 2025. Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review. International Journal of Medicine in Developing Countries, Online First: 21 Oct, 2025. doi:10.24911/IJMDC.51-1757828347


Chicago Style

Elboraei, Yahia Abdelgawad Elsayed, Dala Saad Alanazi, Nouf Sami Alanazi, Layali Khaled Alruwaili, Shahad Mohamed Alanazi, Shahad Abdulaziz Almohileb, Jood Ghazi Alanazi, and Joud M. Alkhidhr. "Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review." International Journal of Medicine in Developing Countries Online First: 21 Oct, 2025. doi:10.24911/IJMDC.51-1757828347


MLA (The Modern Language Association) Style

Elboraei, Yahia Abdelgawad Elsayed, Dala Saad Alanazi, Nouf Sami Alanazi, Layali Khaled Alruwaili, Shahad Mohamed Alanazi, Shahad Abdulaziz Almohileb, Jood Ghazi Alanazi, and Joud M. Alkhidhr. "Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review." International Journal of Medicine in Developing Countries Online First: 21 Oct, 2025. Web. 22 Oct 2025 doi:10.24911/IJMDC.51-1757828347


APA (American Psychological Association) Style

Elboraei, Y. A. E., Alanazi, . D. S., Alanazi, . N. S., Alruwaili, . L. K., Alanazi, . S. M., Almohileb, . S. A., Alanazi, . J. G. & Alkhidhr, . J. M. (2025) Evaluating the diagnostic accuracy of clinical, radiological, and laboratory criteria for acute mastoiditis in emergency settings: a systematic review. International Journal of Medicine in Developing Countries, Online First: 21 Oct, 2025. doi:10.24911/IJMDC.51-1757828347




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