Factors associated with surgery and imaging characteristics in severe orbital infections.

May 16, 2022

Contributor: Peter J Gill,Olivier Drouin,Catherine Pound,Julie Quet,Gita Wahi,Ann Bayliss,Gemma Vomiero,Jessica Foulds,Ronik Kanani,Mahmoud Sakran,Anupam Sehgal,Eleanor Pullenayegum,Elysa Widjaja,Arun Reginald,Nikolaus E Wolter,Semipe Oni,Rashid Anwar,Jessica Cichon,Hossam Louriachi,Yipeng Ge,Nardin Kirolos,Ashaka Patel,Hardika Jasani,Emily Kornelsen,Ashton Chugh,Sandra Gouda,Susan Akbaroghli,Morgyn McKerlie,Patricia C Parkin,Sanjay Mahant,

Factors associated with surgery and imaging characteristics in severe orbital infections.

To evaluate risk factors associated with surgical intervention and subperiosteal/orbital abscess in hospitalized children with severe orbital infections.
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.
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 9-120 mg/L (aOR 2.8, 95% CI 1.3-5.9), elevated WBC 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 prior to hospital admission, sex, presence of a chronic disease, temperature above 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%).
In children hospitalized with severe orbital infections, older age, elevated CRP, elevated WBC, proptosis, and subperiosteal/orbital abscess were predictors of surgical intervention.

Copyright © 2022 Elsevier Inc. All rights reserved.

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About The Expert

Peter J Gill

The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada. Electronic address: peter.gill@sickkids.ca.

Olivier Drouin

Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal.

Catherine Pound

Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.

Julie Quet

Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.

Gita Wahi

Department of Pediatrics, McMaster University, McMaster Children’s Hospital, Hamilton, Ontario, Canada.

Ann Bayliss

Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada.

Gemma Vomiero

Department of Pediatrics, University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada.

Jessica Foulds

Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada.

Ronik Kanani

North York General Hospital, University of Toronto, Toronto, Ontario, Canada.

Mahmoud Sakran

Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, Ontario, Canada; Research, Lakeridge Health, Oshawa, Ontario, Canada.

Anupam Sehgal

Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada.

Eleanor Pullenayegum

Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Elysa Widjaja

The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Arun Reginald

The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada.

Nikolaus E Wolter

The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.

Semipe Oni

The Hospital for Sick Children, Toronto, Ontario, Canada.

Rashid Anwar

The Hospital for Sick Children, Toronto, Ontario, Canada.

Jessica Cichon

The Hospital for Sick Children, Toronto, Ontario, Canada.

Hossam Louriachi

Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada.

Yipeng Ge

Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.

Nardin Kirolos

Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.

Ashaka Patel

Department of Pediatrics, McMaster University, McMaster Children’s Hospital, Hamilton, Ontario, Canada.

Hardika Jasani

Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada.

Emily Kornelsen

Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada.

Ashton Chugh

Department of Pediatrics, University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada.

Sandra Gouda

Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada.

Susan Akbaroghli

North York General Hospital, University of Toronto, Toronto, Ontario, Canada.

Morgyn McKerlie

Kingston Health Sciences Centre, Queens University, Kingston, Ontario, Canada.

Patricia C Parkin

The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.

Sanjay Mahant

The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.

References

PubMed