Changes in the Management of Severe Orbital Infections Over Seventeen Years

Author:

Krueger Carsten1,Mahant Sanjay1234,Begum Nurshad1,Widjaja Elysa56,Science Michelle7,Parkin Patricia C.1234,Gill Peter J.1234

Affiliation:

1. Pediatric Outcomes Research Team, Divisions of Pediatric Medicine and

2. Departments of Pediatrics and

3. Child Health Evaluative Sciences and

4. Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; and

5. Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada

6. Medical Imaging, Faculty of Medicine, and

7. Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada;

Abstract

OBJECTIVES: Periorbital and orbital cellulitis are common but serious infections in children. Management of these infections varies because of an absence of clinical guidelines, but it is unclear if management within institutions has changed over time. We compared the management and outcomes of children hospitalized with periorbital and orbital cellulitis in 2 eras. METHODS: Data were extracted from records of children hospitalized at a tertiary care children’s hospital with periorbital or orbital cellulitis from 2000 to 2005 and 2012 to 2016. Patient demographics, cross-sectional imaging, antibiotic and corticosteroid use, length of stay, and surgical rates were collected. Data from the eras were compared by using descriptive statistics, t tests, Mann–Whitney U tests, Fisher’s exact tests, and χ2 tests. RESULTS: There were 318 children included, 143 from 2000 to 2005 and 175 from 2012 to 2016. Compared with the first era, in the second era there were increased rates of MRI (5% vs 11%, P = .04), although rates of computed tomography scan use remained unchanged (60% vs 65%); increased number (1 vs 3, P < .01) and spectrum of antibiotics; increased use of intranasal corticosteroids (3% vs 49%, P < .01); and subspecialty consultation (89% vs 99%, P = .01). There were no differences in length of stay, readmission, or surgical rates between eras. CONCLUSIONS: There has been considerable change in the management of hospitalized children with severe orbital infections at our institution, including the rates of MRI, number and spectrum of antibiotics used, use of adjunctive agents, and increased subspecialty involvement with no observed impact on clinical outcomes. Future research is needed to rationalize antimicrobial therapy and reduce low-value health care.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health

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