Management of paediatric periorbital cellulitis: Our experience of 243 children managed according to a standardised protocol 2012-2015

Int J Pediatr Otorhinolaryngol. 2016 Aug;87:134-8. doi: 10.1016/j.ijporl.2016.06.025. Epub 2016 Jun 7.

Abstract

Introduction: Paediatric periorbital cellulitis is a common condition. Accurate assessment can be challenging and appropriate use of CT imaging is essential. We audited admissions to our unit over a four year period, with reference to CT scanning and adherence to our protocol.

Methods: Retrospective audit of paediatric patients admitted with periorbital cellulitis, 2012-2015.

Results: Total of 243 patients included, mean age 4.7 years with slight male predominance, the median length of admission was 2 days. 48/243 (20%) underwent CT during admission, 25 (52%) of these underwent surgical drainage. As per protocol, CT brain performed with all orbital scans; no positive intracranial findings on any initial scan. Three children developed intracranial complications subsequently; all treated with antibiotics. Our re-admission rate within 30 days was 2.5%.

Conclusions: Our audit demonstrates benefit of standardising practice and the low CT rate, with high percentage taken to theatre and no missed abscesses, supports the protocol. There may be an argument to avoid CT brain routinely in all initial imaging sequences in those children without neurological signs or symptoms.

Keywords: Cellulitis; Periorbital; Protocol.

MeSH terms

  • Abscess / diagnostic imaging
  • Abscess / therapy*
  • Anti-Bacterial Agents / therapeutic use*
  • Brain / diagnostic imaging
  • Cellulitis / diagnostic imaging
  • Cellulitis / therapy*
  • Child
  • Child, Preschool
  • Disease Management
  • Drainage*
  • Female
  • Haemophilus Infections / diagnostic imaging
  • Haemophilus Infections / therapy*
  • Haemophilus influenzae
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Medical Audit
  • Orbital Diseases / diagnostic imaging
  • Orbital Diseases / therapy*
  • Pediatrics
  • Retrospective Studies
  • Streptococcal Infections / diagnostic imaging
  • Streptococcal Infections / therapy*
  • Streptococcus anginosus
  • Streptococcus pneumoniae
  • Streptococcus pyogenes
  • Tomography, X-Ray Computed

Substances

  • Anti-Bacterial Agents