Multiple Factors Tied to Pediatric Orbital Infections
Last Updated: 2010-03-09 15:45:23 -0400 (Reuters Health)
In the April issue of Pediatrics, lead author Dr. Tiffany F. Rudloe of Children's Hospital Boston and colleagues report on their review of emergency department data on 918 children with suspected acute clinical periorbital or orbital cellulitis. None had a history of craniofacial surgery or trauma or an external source of infection.
Emergency physicians had ordered computed tomography (CT) scans for 298 children; in 111, the scans showed an abscess. Proptosis, pain with external ocular movement, and ophthalmoplegia were associated with presence of an abscess, but only in about half of the patients.
Other factors significantly associated with abscess were a peripheral blood neutrophil count greater than 10,000/uL, periorbital edema, the absence of infectious conjunctivitis, age greater than 3 years, and previous antibiotic therapy.
Overall, the risk of abscess ranged from 0.4% for patients with none of these factors to more than 40% for children with all of them.
Summing up, Dr. Rudloe told Reuters Health by email, "Our study shows that in addition to the known high risk findings of ophthalmoplegia and proptosis, patients who have moderate to severe periorbital edema or an absolute neutrophil count of greater than 10,000 cells/mm3 also fall into a high risk category, and CT imaging should be expedited."
The investigators call the 12% risk of abscess in their cohort "sobering." The absence of classic features of abscess in so many patients is so worrisome because treatment delay leads to blindness in up to 10% of cases, they add. In fact, 2 of their 111 patients became blind.
However, the authors point out, "In our model, almost two thirds of the patients can be classified at low risk, eliminating the need for emergent imaging."
"We therefore recommend expedited imaging of those patients who fall into the high risk category, with strong consideration of imaging for those in the intermediate risk category," they add.
Pediatrics 2010.
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