Management of pediatric orbital cellulitis: A systematic review

Wong, Stephanie J.; Levi, Jessica R.

doi:10.1016/j.ijporl.2018.05.006

Cited by 109 publications

(131 citation statements)

References 61 publications

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“…On the other hand, it is also possible that a proportion of children with a small fluid collection on imaging may have improved with antibiotics alone. There is a growing body of evidence in children with other head and neck infections (eg, retropharyngeal abscess and orbital cellulitis with periosteal abscess) [13][14][15] that suggests that children with small abscesses often improve with antibiotic therapy alone. In children with cervical lymphadenitis who have small or developing abscesses identified via routine imaging on presentation, clinicians may be driven to pursue a surgical intervention with uncertain benefit.…”

Section: Discussionmentioning

confidence: 99%

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Desai

Shah

Hall

et al. 2019

Journal of Hospital Medicine

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OBJECTIVES: This study aimed to describe variation in imaging practices and examine the association between early imaging and outcomes in children hospitalized with cervical lymphadenitis. METHODS: This multicenter cross-sectional study included children between two months and 18 years hospitalized with cervical lymphadenitis between 2013 and 2017. Children with complex chronic conditions, transferred from another institution, and with prior hospitalizations for lymphadenitis were excluded. To examine hospital-level variation, we calculated the proportion of children at each hospital who received any imaging study, early imaging (conducted on day 0 of hospitalization), multiple imaging studies, and CT imaging. Generalized linear or logistic mixed effects models examined the association between early imaging and outcomes (ie, multiple imaging studies, surgical drainage, 30-day readmission, and length of stay) while accounting for patient demographics, markers of illness duration and severity, and clustering by hospital. RESULTS: Among 10,014 children with cervical lymphadenitis, 61% received early imaging. There was hospital-level variation in imaging practices. Compared with children who did not receive early imaging, children who received early imaging presented increased odds of having multiple imaging studies (adjusted odds ratio [aOR] 3.0; 95% CI: 2.6-3.6), surgical drainage (aOR 1.3, 95%CI: 1.1-1.4), and 30-day readmission for lymphadenitis (aOR 1.5, 95%CI: 1.2-1.9), as well as longer lengths of stay (adjusted rate ratio 1.2, 95%CI: 1.1-1.2). CONCLUSIONS: Children receiving early imaging had more resource utilization and intervention than those without early imaging. Our findings may represent a cascade effect, in which routinely conducted early imaging prompts clinicians to pursue additional testing and interventions in this population.

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Section: Discussionmentioning

confidence: 99%

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Desai

Shah

Hall

et al. 2019

Journal of Hospital Medicine

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“…At the moment there is no consensus concerning antibiotic protocols. However a conservatory treatment based on empirical antibiotherapy is recommended [30]. In our study, the treatment of choice was amoxicillin clavulanic acid prescribed in the majority of our cases [21].…”

Section: Methodsmentioning

confidence: 99%

“…In literature, the use of surgery is very rare when it comes to preseptal cellulitis and varies between 0 to 11% in most of the series [30]. However the preseptal cellulitis can be a real danger can alter the visual prognosis necessitating a surgical drain in certain cases [32].…”

Section: Methodsmentioning

confidence: 99%

“…In our study, 3 cases of pre septal cellulitis necessitated a surgical drain. A lot of studies showed that retro spetal cellulitis can also be treated without the use of surgery (success rate of 77 to 100%) [30]. A recent large cohort (n = 3041 children) in USA showed that age, ophthalmologic comorbidity, and conjunctival edema were signi cantly associated with surgery [33].…”

Section: Methodsmentioning

confidence: 99%

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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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“…In apparent periorbital cellulitis, what findings should prompt paranasal sinus CT imaging? Reduced visual acuity or color vision Ophthalmoplegia Relative afferent pupillary defect Proptosis Bilateral periorbital edema Neurological signs Inability to fully assess eye No improvement after 24 hours of wide spectrum antibiotic treatment Swinging pyrexia persisting over 36 hours. …”

Section: Questionmentioning

confidence: 99%

Pediatric intraorbital abscess: Early recognition and management

McKenna

Reddy

McKenna

2019

Clinical Case Reports

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Key Clinical Message Orbital involvement occurs in 85% of complicated acute sinusitis and is more prevalent in children. Prompt differentiation between the more common periorbital (preseptal) cellulitis and infections, posterior to the orbital septum (including orbital cellulitis/abscess), is essential due to the latter's risk of irreversible optic neuropathy, intracranial spread and death.

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Management of pediatric orbital cellulitis: A systematic review

Cited by 109 publications

References 61 publications

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Management of Periorbital and Orbital Cellulitis at the Pediatric Emergency Department

Pediatric intraorbital abscess: Early recognition and management

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