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What is the risk of missing orbital cellulitis in children?
  1. Laila F Ibrahim1,2,3,
  2. Franz E Babl2,3,4,
  3. Sandy M Hopper2,3,4,
  4. Penelope A Bryant2,3,5,6
  1. 1 General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  3. 3 Murdoch Children's Research Institute, Parkville, Victoria, Australia
  4. 4 Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  5. 5 Infectious Diseases Unit, General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
  6. 6 Hospital-in-the-Home, The Royal Children's Hospital, Parkville, Victoria, Australia
  1. Correspondence to Dr Penelope A Bryant, General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia; penelope.bryant{at}rch.org.au

Abstract

Background Preseptal cellulitis can be difficult to distinguish from orbital cellulitis in children. The majority of patients with periorbital infections are admitted for intravenous antibiotics. This study aimed to investigate the risk of missing orbital cellulitis and the outcomes of missed patients.

Methods A prospective cohort study of children aged 3 months to 18 years diagnosed with preseptal cellulitis over 5 years. Data were collected prospectively, including demographics, clinical features and outcomes.

Results There were 216 children diagnosed with preseptal cellulitis. 75 (35%) were treated with oral antibiotics and 141 (65%) with intravenous antibiotics. 5 (2%) children who were hospitalised were subsequently determined to have orbital cellulitis. All 5 children were either a young infant with difficult eye examination, or had headache or vomiting.

Conclusion The risk of missing orbital cellulitis is low. Young infants with difficult eye examination or the presence of headache or vomiting should increase suspicion of orbital cellulitis.

  • ophthalmology
  • health services research

Data availability statement

Data are available on reasonable request. De-identified data are available on reasonable request.

https://doi.org/10.1136/archdischild-2020-320590

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    Data availability statement

    Data are available on reasonable request. De-identified data are available on reasonable request.

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    Footnotes

    • Contributors LFI conceptualised, designed and coordinated the study, carried out the initial and subsequent data analysis, drafted the initial manuscript, revised subsequent drafts and approved the final manuscript as submitted. PAB, FEB and SMH were involved in the design of the study, provided input into data analysis, reviewed and revised the manuscript and approved the final draft. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding This study was funded in part by grants from the RCH Foundation, the Murdoch Children’s Research Institute (MCRI), the Victorian Department of Health, Melbourne Australia. LFI was supported in part by a scholarship from AVANT Mutual Group Ltd, Melbourne, the Melbourne Children’s Campus Postgraduate Health Research Scholarship, the Doctor Nicholas Collins Fellowship and a Melbourne Campus Clinician Scientist Fellowship. PAB was in part supported by a Melbourne Campus Clinician Scientist Fellowship, Melbourne and a National Health and Medical Research Council (NHMRC) Investigator grant. FEB was supported in part by a grant from the RCH Foundation and a Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia and a National Health and Medical Research Council NHMRC Practitioner Fellowship, Canberra, Australia. The emergency research group, MCRI, is in part supported by an NHMRC Centre for Research Excellence Grant for Paediatric Emergency Medicine, Canberra, Australia and the Victorian government infrastructure support programme.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.