Andrew Burbidge, Thomas Coleman, Eric Mills, Ellie McEwen, Tania Sulaksana, Manjushree Bhate, Julie Adamson
Purpose: The primary aim was to report outcome data, for management of paediatric cases presenting with periorbital and orbital cellulitis, at a large ter- tiary paediatric referral hospital.
Methods: A single-centre retrospective review was conducted; for consecutive paediatric admissions with ICD-10 coded diagnoses: periorbital/orbital cellulitis, between January 1st 2007 and January 1st 2017, at the John Hunter Children?s Hospital, Newcastle, NSW.
Primary analysis was performed on baseline and clinical demographics; microbiology; CT ftndings including Chandler classiftcation; surgical outcomes and complications. Data were extracted, modelled and analysed via SPSS software.
Results: Two-hundred-thirty-eight patients were ana- lysed. Mean age was 5.9 years, 62.2% were males. Peri- orbital cellulitis was present in 227 (89.9%), orbital cellulitis in 24 (10.1%) with 13 cases overlapping.Microbiology was collected in 48.8%. CT scanning per- formed in 21.0%, 91.7% of orbital cases underwent CT. The relative-risk of surgical intervention in orbital cellulitis cases was 12.9 times (95% CI =5.1-32.8) that of periorbital cases. 54.2% of orbital cases required surgery.
Cases of orbital cellulitis were 8.23 (95% CI =3.0- 22.8) times more likely to experience complications, compared to the pre-septal cohort. 33.3% experi- enced complications, including: corneal ulceration, sub-periosteal abscess, ICU admission, seizures, sepsis, and meningitis. There were no deaths.
Conclusion: In this ten-year review of periorbital and orbital infective admissions to a major tertiary paedi- atric centre, orbital cellulitis occurred in 10.1% and was frequently associated with complications.
This large Australian dataset of high-acuity presenta- tions demonstrates the current trends in pathology, management and complications. This article estab- lishes the basis for a future clinical practice guidelines, directing management of undifferentiated peri-orbital infections.