Changing Evaluation and Management of Severe Orbital Infections

Abstract

Research Article| October 01 2021 Changing Evaluation and Management of Severe Orbital Infections AAP Grand Rounds (2021) 46 (4): 46. https://doi.org/10.1542/gr.46-4-46 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Changing Evaluation and Management of Severe Orbital Infections. AAP Grand Rounds October 2021; 46 (4): 46. https://doi.org/10.1542/gr.46-4-46 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: magnetic resonance imaging, orbital cellulitis, cellulitis, periorbital cellulitis, adrenal corticosteroids, empirical antibiotic therapy, glucocorticoids, mineralocorticoids, saline solutions, sinusitis Source: Krueger C, Mahant S, Begum N, et al Changes in the management of severe orbital infections over seventeen years. Hosp Pediatr. 2021;11(6):613-621; doi:10.1542/hpeds.2020-001818Google Scholar Investigators from The Hospital for Sick Children and the University of Toronto, both in Toronto, Canada, conducted a retrospective study to compare management and outcomes among children hospitalized at their institution with severe orbital infections (including periorbital cellulitis, orbital cellulitis, and subperiosteal or orbital abscess) during 2 periods (2000–2005 and 2012–2016). Study participants were identified by ICD-9 and ICD-10 codes, Canadian version. The medical records of the identified children were reviewed, and data on demographics, antibiotic usage, use of adjuvant therapies (including intranasal corticosteroids and intranasal saline rinses), results of radiologic tests, length of stay (LOS), and complications were abstracted. Antibiotics were categorized as narrow or broad spectrum based on a standardized classification system. Differences in patient characteristics, management, and outcomes were assessed with t-tests or Mann-Whitney U tests for continuous data and chi-square of Fisher Exact tests for categorical data. There were 318 children identified with severe orbital infections, including 143 from 2000–2005 (Time Period 1) and 175 from 2012 2012–2016 (Time Period 2). The median age of study patients was 5.4 years, and 68.9% were male. Overall, the demographics of study participants from the 2 time periods were similar. Children with periorbital cellulitis were significantly younger than those diagnosed with orbital cellulitis (mean ages 4.0 and 6.4 years, respectively; P ≤0.01). Overall, a bacteriology etiology was identified in limited number of patients; the most common organisms isolated were Streptococcus anginosus (N = 21) and S aureus (N = 17). Among the 199 children (62.6%) for whom computerized tomography (CT) scans were obtained, 88% had sinusitis, 80% had orbital involvement, and 55% had orbital or subperiosteal abscess. The rate of CT use in patients during the 2 time periods were similar (60% in Time Period 1 and 65% in Time Period 2); disease severity based on CT findings also were similar. There was a significant increase in use of MRI in Time Period 2 compared to Time Period 1 (11% and 4%, respectively; P = 0.04). There also were significant increases in the number of intravenous antibiotics prescribed per patient in Time Period 2 (median value 3 vs 1 in Time Period 1; P ≤0.01), use of broad-spectrum antibiotics, use of intranasal corticosteroids (49% and 3%, respectively; P ≤0.01), and intranasal saline rinses (48% and 1%, respectively; P ≤0.01). LOS for children with periorbital cellulitis decreased for those hospitalized in Time Period 2 (median 45.3 hours vs 67.3 hours for those in Time Period 1; P = 0.01), but the LOS was similar for those with orbital cellulitis. Overall, severe complications occurred in 3.8% of study patients and included Potty’s puffy tumor (N = 8), intracranial extension of infection (N = 8), and cavernous sinus thrombosis (N = 3). The authors conclude that... You do not currently have access to this content.