Association of systemic corticosteroids and clinical outcomes in children hospitalised with severe orbital infections.

OBJECTIVES

To evaluate the association between corticosteroid use and clinical outcomes in children hospitalised with severe orbital infections, and to describe practice patterns of systemic corticosteroid use.

DESIGN

Multi-site observational cohort study using hospital data from 2009 to 2018.

SETTING

Canadian children's hospitals (7) and community hospitals (3).

PATIENTS: Children 2 months and 18 years hospitalised with severe orbital infections.

INTERVENTIONS: Systemic corticosteroids at any time MAIN OUTCOME MEASURES: Length of hospital stay and surgical intervention using time-to-event Cox proportional hazards multivariable regression models to account for potential differences in timing of corticosteroid use (early, ≤24 hours or late, >24 hours after admission), with adjustment for covariates.

RESULTS

Of the 1479 hospitalised children, 876 (59.2%) were male and median age was 5.3 years (IQR 2.2 to 9.8). Of the 65 (4.4%) who received corticosteroids, over half (53.8%) received them early. Median length of stay was 75.9 hours (IQR 47.1 to 130.4) and 98 (6.6%) underwent surgical intervention. Corticosteroid use was associated with delayed discharge and prolonged hospitalisation, as reflected by a HR of 0.73 (95% CI 0.55 to 0.96) in adjusted analyses. However, systemic corticosteroids had no association with surgical intervention (HR 0.82, 95% CI 0.36 to 1.88).

CONCLUSION

In a large cohort of hospitalised children with severe orbital infections, corticosteroids were used infrequently, and when used, were not associated with improved clinical outcomes. Further high-quality trial evidence is needed to determine if routine corticosteroids are safe and effective.