Factors Associated with Surgery and Imaging Characteristics in Severe Orbital Infections.
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Gill Peter J, Drouin Olivier, Pound Catherine, Quet Julie, Wahi Gita, Bayliss Ann, Vomiero Gemma, Foulds Jessica, Kanani Ronik, Sakran Mahmoud, Sehgal Anupam, Pullenayegum Eleanor, Widjaja Elysa, Reginald Arun, Wolter Nikolaus E, Oni Semipe, Anwar Rashid, Cichon Jessica, Louriachi Hossam, Ge Yipeng, Kirolos Nardin, Patel Ashaka, Jasani Hardika, Kornelsen Emily, Chugh Ashton, Gouda Sandra, Akbaroghli Susan, McKerlie Morgyn, Parkin Patricia C, Mahant Sanjay, Orbital Cellulitis (POC) Multicenter Study Group, Canadian Pediatric Inpatient Research Network (PIRN)
Аннотация
STUDY DESIGN: We conducted a multicenter cohort study of children 2 months to 18 years hospitalized with periorbital or orbital cellulitis from 2009 to 2018 at 10 hospitals in Canada. Clinical details were extracted, and patients were categorized as undergoing surgical or medical-only management. Primary outcome was surgical intervention and the main secondary outcome was clinically important imaging. Logistic regression was used to identify predictors.
RESULTS: Of 1579 patients entered, median age was 5.4 years, 409 (25.9%) had an orbital/subperiosteal abscess, and 189 (12.0%) underwent surgery. In the adjusted analysis, the risk of surgical intervention was associated with older age (age 9 to <14: aOR 3.9, 95% CI 2.3-6.6; and age 14 to ≤18 years: aOR 7.0, 95% CI 3.4-14.1), elevated C-reactive protein >120 mg/L (aOR 2.8, 95% CI 1.3-5.9), elevated white blood cell count of 12-20 000/μL (aOR 1.7, 95% CI 1.1-2.6), proptosis (aOR 2.6, 95% CI 1.7-4.0), and subperiosteal/orbital abscess (aOR 5.3, 95% CI 3.6-7.9). There was no association with antibiotic use before hospital admission, sex, presence of a chronic disease, temperature greater than 38.0°C, and eye swollen shut. Complications were identified in 4.7% of patients, including vision loss (0.6%), intracranial extension (1.6%), and meningitis (0.8%).
CONCLUSIONS: In children hospitalized with severe orbital infections, older age, elevated C-reactive protein, elevated white blood cell count, proptosis, and subperiosteal/orbital abscess were predictors of surgical intervention.