International journal of pediatric otorhinolaryngology · 2023
Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study.
Многоцентровое исследованиеНаблюдательное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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McKerlie Morgyn F, Wolter Nikolaus E, Mahant Sanjay, Cichon Jessica, Widjaja Elysa, Drouin Olivier, Pound Catherine, Quet Julie, Wahi Gita, Bayliss Ann, Vomiero Gemma, Foulds Jessica L, Kanani Ronik, Sakran Mahmoud, Sehgal Anupam, Borkhoff Cornelia M, Pullenayegum Eleanor, Reginald Arun, Parkin Patricia C, Gill Peter J, Periorbital and Orbital Cellulitis (POC), Multicentre Study Group and Canadian Pediatric Inpatient Research Network (PIRN)
Аннотация
IMPORTANCE: Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage.
OBJECTIVE: To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention.
DESIGN: We conducted an observational cohort study using medical records from children hospitalized between 2009 and 2018.
SETTING: Multicentre study using data from 6 children's hospitals.
PARTICIPANTS: Children were included if they were between 2 months and 18 years of age and hospitalized for an orbital infection with an abscess confirmed on cross-sectional imaging.
EXPOSURE: Subperiosteal or orbital abscess volume.
MAIN OUTCOME AND MEASURES: The primary outcome was surgical intervention, defined as subperiosteal and/or orbital abscess drainage. Multivariable logistic regression was performed to assess the association of abscess volume with surgery. To determine the optimal abscess volume cut-point, receiver operating characteristic (ROC) analysis was performed using the Youden Index to optimize sensitivity and specificity.
RESULTS: Of the 150 participants (mean [SD] age, 8.5 [4.5] years), 68 (45.3%) underwent surgical intervention. On multivariable analysis, larger abscess volume and non-medial abscess location were associated with surgical intervention (abscess volume: adjusted odds ratio [aOR], 1.46; 95% CI, 1.11-1.93; abscess location: aOR, 3.46; 95% CI, 1.4-8.58). ROC analysis demonstrated an optimal abscess volume cut-point of 1.18 mL [AUC: 0.75 (95% CI 0.67-0.83) sensitivity: 66%; specificity: 79%]. CONCLUSIONS AND RELEVANCE: In this multicentre cohort study of 150 children with subperiosteal or orbital abscess, larger abscess volume and non-medial abscess location were significant predictors of surgical intervention. Children with abscesses >1.18 mL should be considered for surgery.
OBJECTIVE: To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention.
DESIGN: We conducted an observational cohort study using medical records from children hospitalized between 2009 and 2018.
SETTING: Multicentre study using data from 6 children's hospitals.
PARTICIPANTS: Children were included if they were between 2 months and 18 years of age and hospitalized for an orbital infection with an abscess confirmed on cross-sectional imaging.
EXPOSURE: Subperiosteal or orbital abscess volume.
MAIN OUTCOME AND MEASURES: The primary outcome was surgical intervention, defined as subperiosteal and/or orbital abscess drainage. Multivariable logistic regression was performed to assess the association of abscess volume with surgery. To determine the optimal abscess volume cut-point, receiver operating characteristic (ROC) analysis was performed using the Youden Index to optimize sensitivity and specificity.
RESULTS: Of the 150 participants (mean [SD] age, 8.5 [4.5] years), 68 (45.3%) underwent surgical intervention. On multivariable analysis, larger abscess volume and non-medial abscess location were associated with surgical intervention (abscess volume: adjusted odds ratio [aOR], 1.46; 95% CI, 1.11-1.93; abscess location: aOR, 3.46; 95% CI, 1.4-8.58). ROC analysis demonstrated an optimal abscess volume cut-point of 1.18 mL [AUC: 0.75 (95% CI 0.67-0.83) sensitivity: 66%; specificity: 79%]. CONCLUSIONS AND RELEVANCE: In this multicentre cohort study of 150 children with subperiosteal or orbital abscess, larger abscess volume and non-medial abscess location were significant predictors of surgical intervention. Children with abscesses >1.18 mL should be considered for surgery.