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Early diagnosis is often delayed due to nonspecific symptoms. This study aimed to identify clinical and laboratory predictors of CSVT in children with mastoiditis to support timely imaging and treatment. We performed a retrospective case\u2013control study across two university-affiliated centers from 1999 to 2022 of children with acute mastoiditis who underwent neuroimaging. Clinical, laboratory, imaging, and treatment data from 81 children (40 with CSVT and 41 without) were compared. Logistic regression was used to identify predictors of CSVT. Four variables were independently associated with CSVT: abnormal neurologic findings (OR 18.24, 95% CI 3.12\u2013150.62,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01), persistent fever\u2009&gt;\u200972 h despite antibiotic treatment (OR 4.67, 95% CI 1.23\u201319.92,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03), prior antibiotic use (OR 4.74, 95% CI 1.27\u201321.16,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03), and elevated C-reactive protein (CRP) levels (OR 1.14 per mg\/dL, 95% CI 1.05\u20131.27,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03). The model had strong discrimination (AUC\u2009=\u20090.85). Thrombus resolution was documented in 25 of 32 children (median, 3.8 months). Anticoagulation was safe and effective. Thrombophilia testing had limited diagnostic yield.\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : Abnormal neurologic signs, prolonged fever, elevated CRP, and recent antibiotic use are key predictors of CSVT in pediatric mastoiditis. Early imaging and timely anticoagulation contribute to favorable outcomes. Routine thrombophilia screening may have limited utility. These findings may help general pediatricians identify children who need timely referral for neuroimaging and specialist care.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">What is known:<\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\u2022 Cerebral sinus venous thrombosis (CSVT) is a rare complication of mastoiditis in children.<\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\u2022\u00a0Diagnosis of CSVT may be delayed due to nonspecific symptoms.<\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\u2022\u00a0Anticoagulation is generally safe in children.<\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">What is new:<\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\u2022\u00a0We identified four independent clinical predictors of CSVT.<\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\u2022\u00a0Early MRI follow-up may allow shorter anticoagulation duration.<\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-025-06477-y","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T17:18:05Z","timestamp":1759425485000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute mastoiditis\u2013associated cerebral sinus venous thrombosis in children: a retrospective review"],"prefix":"10.1007","volume":"184","author":[{"given":"Yael","family":"Sellam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elchanan","family":"Zloczower","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maru","family":"Gete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoshana","family":"Revel-Vilk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avigail","family":"Eisenberg-Wygoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Lahav","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noam","family":"Bartov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonatan","family":"Lahav","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Guri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ifat","family":"Kvint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Nahum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Ben-Ami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"issue":"10","key":"6477_CR1","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1016\/j.ijporl.2012.07.002","volume":"76","author":"A Groth","year":"2012","unstructured":"Groth A, Enoksson F, Hultcrantz M, Stalfors J, Stenfeldt K, Hermansson A (2012) Acute mastoiditis in children aged 0\u201316 years\u2014a national study of 678 cases in Sweden comparing different age groups. 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