Preseptal and Orbital Cellulitis: Thirteen Years of Experience and a Novel Scoring System (SNIPPED Score) for Differentiation

Abstract

We aimed to evaluate clinical and laboratory characteristics of children with preseptal cellulitis (PC) or orbital cellulitis (OC) and to determine whether easily-accessible parameters could be used to predict OC. The data of children diagnosed with PC or OC between January 2008 and December 2020 were evaluated. Patients aged between 1 month and 18 years who were treated with intravenous antibiotics were included. Logistic regression analysis was performed to identify possible parameters in differentiating between PC and OC. A beta coefficient-based method was used to derive the scoring system. A total of 375 patients [202 (53.9%) boys], of whom 35 (9.3%) had OC, were evaluated. Median age was 44 (min-max: 1-192) months. Compared to those with PC, patients with OC were older (p = 0.001), had fever and upper respiratory tract infection (URTI) symptoms more frequently, and demonstrated prolonged symptom and hospitalization times (p˂0.001 for all). Significant differences between groups were observed for numerous parameters; however, logistic regression analysis revealed only five parameters independently associated with OC. The SNIPPED score variables and weights were as follows: sinusitis (2 points), neutrophil-to-lymphocyte ratio > 6.78 (3 points), platelet count > 420.5 x103/mm3 (2 points), proptosis (4 points) and duration of symptoms ≥ 4 days (4 points). A cut-off of ≥ 7 points for OC diagnosis was found to have 91.4% sensitivity, 96.2% specificity, 71.1% PPV, 99.1% NPV and 95.7% accuracy. Conclusion: In addition to showing previously known properties of OC versus PC, our study demonstrated that easily-accessible parameters could be used for the identification of OC.