Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study Journal Articles uri icon

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abstract

  • IMPORTANCE: Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage. OBJECTIVE: To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention. DESIGN: We conducted an observational cohort study using medical records from children hospitalized between 2009 and 2018. SETTING: Multicentre study using data from 6 children's hospitals. PARTICIPANTS: Children were included if they were between 2 months and 18 years of age and hospitalized for an orbital infection with an abscess confirmed on cross-sectional imaging. EXPOSURE: Subperiosteal or orbital abscess volume. MAIN OUTCOME AND MEASURES: The primary outcome was surgical intervention, defined as subperiosteal and/or orbital abscess drainage. Multivariable logistic regression was performed to assess the association of abscess volume with surgery. To determine the optimal abscess volume cut-point, receiver operating characteristic (ROC) analysis was performed using the Youden Index to optimize sensitivity and specificity. RESULTS: Of the 150 participants (mean [SD] age, 8.5 [4.5] years), 68 (45.3%) underwent surgical intervention. On multivariable analysis, larger abscess volume and non-medial abscess location were associated with surgical intervention (abscess volume: adjusted odds ratio [aOR], 1.46; 95% CI, 1.11-1.93; abscess location: aOR, 3.46; 95% CI, 1.4-8.58). ROC analysis demonstrated an optimal abscess volume cut-point of 1.18 mL [AUC: 0.75 (95% CI 0.67-0.83) sensitivity: 66%; specificity: 79%]. CONCLUSIONS AND RELEVANCE: In this multicentre cohort study of 150 children with subperiosteal or orbital abscess, larger abscess volume and non-medial abscess location were significant predictors of surgical intervention. Children with abscesses >1.18 mL should be considered for surgery.

authors

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

publication date

  • August 2023