Management of paediatric periorbital cellulitis: Our experience of 243 children managed according to a standardised protocol 2012–2015

Crosbie, Robin; Nairn, Jonathan; Kubba, Haytham

doi:10.1016/j.ijporl.2016.06.025

Cited by 39 publications

(30 citation statements)

References 13 publications

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“…A fundamental aspect in the treatment of periorbital cellulitis is assessing the severity of the infection in order to provide appropriate management. A retrospective study of 243 patients with periorbital cellulitis found that with the use of a treatment protocol, 98% of patients were treated appropriately with a short admission for inpatient antibiotic therapy . Moreover, in a systemic review of existing periorbital cellulitis guidelines, almost half of guidelines recommended admission in all patients; however, more than a quarter of guidelines required admission for the presence of fever, ocular symptoms, lack of improvement after 24‐48 hours of oral antibiotics, or if patients appear generally unwell .…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective study of 243 patients with periorbital cellulitis found that with the use of a treatment protocol, 98% of patients were treated appropriately with a short admission for inpatient antibiotic therapy. 9 Moreover, in a systemic review of existing periorbital cellulitis guidelines, almost half of guidelines recommended admission in all patients; however, more than a quarter of guidelines required admission for the presence of fever, ocular symptoms, lack of improvement after 24-48 hours of oral antibiotics, or if patients appear generally unwell. 10 Despite the lack of a standardised protocol, with outpatient intravenous therapy, only one patient out of 66 had to be admitted to the hospital due to treatment failure.…”

Section: Comparisons With Other Studiesmentioning

confidence: 99%

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Daily outpatient intravenous antibiotic therapy for the management of paediatric periorbital cellulitis, a retrospective case series

Tritt

Kay‐Rivest

Paradis

et al. 2019

Clinical Otolaryngology

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Objective To evaluate whether outpatient treatment of periorbital cellulitis with daily administration of intravenous antibiotics and physician evaluation is an effective and safe alternative to admission. Design A retrospective chart review study of paediatric patients treated on an outpatient basis for periorbital cellulitis at a tertiary children's hospital between 2013 and 2015 was performed. Children were assessed day by a paediatrician to monitor for resolution of symptoms or complications. Setting The Montreal Children's hospital, a tertiary care centre. Participants Children diagnosed with an uncomplicated periorbital cellulitis secondary to an acute sinusitis or upper respiratory tract infection. Main outcome measures The number of days of intravenous antibiotics, complications or need for subsequent admission. Complications were defined as formation of an abscess or phlegmon confirmed on computerised tomography scan, worsening or recurrent persistent cellulitis, failure to improve on intravenous antibiotics, and intracranial complications. Results Sixty‐six children with a diagnosis of uncomplicated periorbital cellulitis secondary to sinusitis who received intravenous antibiotics via medical day hospital and who fit the inclusion criteria were identified. The mean duration of intravenous antibiotic therapy was 4.1 days. All children received ceftriaxone, with one patient also receiving cefuroxime. Two of 66 patients developed complications; one patient required admission for failure to improve/subperiosteal phlegmon and later underwent functional endoscopic sinus surgery, and one patient developed an eyelid abscess that did not require admission. No patients developed severe neurological or visual deficits. Conclusions Outpatient intravenous therapy with daily reassessment by a physician may be a safe alternative to admission in select cases of periorbital cellulitis without systemic signs of illness.

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Section: Discussionmentioning

confidence: 99%

Section: Comparisons With Other Studiesmentioning

confidence: 99%

Daily outpatient intravenous antibiotic therapy for the management of paediatric periorbital cellulitis, a retrospective case series

Tritt

Kay‐Rivest

Paradis

et al. 2019

Clinical Otolaryngology

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“…Orbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the functional and vital prognosis. It is characterized by the presence of a periorbital acute in ammatory swelling with an infectious origin, that can occur at any age range, but remains more frequent in the pediatric population [1]. There are multiple types of classi cation for orbital cellulitis chandler included [2].…”

Section: Introductionmentioning

confidence: 99%

Management of Periorbital and Orbital Cellulitis at the Pediatric Emergency Department

Lahmini

Bourrous

2020

Preprint

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Background : Orbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the vital and functional prognosis. This study aimed to analyze the epidemiological, therapeutic and evolutional aspects of orbital cellulitis cases treated at the pediatric emergency unit. Patients and methods: retrospective study including all the children aged between 1 month and 15 years treated for orbital cellulitis at the pediatric emergency unit of the Mohamed VI University Hospital of Marrakech over a period of 9 years (1st January 2010-31st December 2018). Results: 129 cases of orbital cellulitis were gathered. Age varied between 1 month and 15 years with a median of age of 4.3 years. Feminine predominance (54%) was noted (sex ratio of 0.84). Preseptal cellulitis had the lead with 101 cases (78.2%). It mainly breaks through sinuses (24%). Fever was present in 101 patients (78.2%). Palpebral edema was constant. Exophthalmia was noted in 18 patients (13.9%), chemosis in 29 cases (22.4%) while ptosis was found in one patient. Bacteriological study conducted in 12 cases was positive in 7 cases. An orbital CT scan was performed in all cases of our study, showing preseptal cellulitis in 101 patients (78.2%), orbital cellulitis in 11 cases (8.5%), subperiosteal abscess in 15 cases (11.6%) and orbital abscess in 2 cases (1.5%). The medical treatment consisted of ceftriaxone, metronidazole and aminoside or amoxicilline clavulanic acid. Surgical treatment was indicated in 8 patients : 3 cases of orbital abscess, 2 cases of periosteal abscess, and 3 cases of abscessed collection of the soft tissues. The evolution was beneficial in all our patients. Conclusion: The majority of our cases had a positive evolution highlighting the advantage of an early diagnosis, and adapted antibiotic and a multidisciplinary patient care making the need for surgery rarely necessary.

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“…Given the severity of potential complications (eg, loss of vision, meningitis and death),4 9 10 up to 51% of children that present to the emergency department (ED) with acute periorbital swelling and redness are hospitalised11 for further investigations, antimicrobial therapy, adjunctive agents, specialty consulting services and surgical intervention. In most centres, children are admitted to the general paediatric inpatient unit, with consultation from otolaryngologists, ophthalmologists and other specialty services 12–15.…”

Section: Introductionmentioning

confidence: 99%

Care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis: protocol for a multicentre, retrospective cohort study

et al. 2019

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IntroductionSkin and soft tissue infections of the eye can be classified based on anatomic location as either anterior to the orbital septum (ie, periorbital cellulitis) or posterior to the orbital septum (ie, orbital cellulitis). These two conditions are often considered together in hospitalised children as clinical differentiation is difficult, especially in young children. Prior studies have identified variation in management of hospitalised children with orbital cellulitis; however, they have been limited either as single centre studies or by the use of administrative data which lacks clinical details important for interpreting variation in care. We aim to describe the care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis.Method and analysisThis is a multisite retrospective cohort study including previously healthy children aged 2 months to 18 years admitted to hospital with periorbital or orbital cellulitis from 2009 to 2018. Clinical data from medical records from multiple Canadian hospitals will be collected, including community and academic centres. Demographic characteristics and study outcomes will be summarised using descriptive statistics, including diagnostic testing, antibiotic therapy, adjunctive therapy, surgical intervention and clinical outcomes. Variation will be described and evaluated using χ² test or Kruskal-Wallis test. Generalised linear mixed models will be used to identify predictors of surgical intervention and longer length of stay.Ethics and disseminationApproval of the study by the Research Ethics Board at each participating site has been obtained prior to data extraction. Study results will be disseminated by presentations at national and international meetings and by publications in high impact open access journals. By identifying important differences in management and outcomes by each hospital, the results will identify areas where care can be improved, practice standardised, unnecessary diagnostic imaging reduced, pharmacotherapy rationalised and where trials are needed.

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Management of paediatric periorbital cellulitis: Our experience of 243 children managed according to a standardised protocol 2012–2015

Cited by 39 publications

References 13 publications

Daily outpatient intravenous antibiotic therapy for the management of paediatric periorbital cellulitis, a retrospective case series

Daily outpatient intravenous antibiotic therapy for the management of paediatric periorbital cellulitis, a retrospective case series

Management of Periorbital and Orbital Cellulitis at the Pediatric Emergency Department

Care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis: protocol for a multicentre, retrospective cohort study

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