Association of systemic corticosteroids and clinical outcomes in children hospitalised with severe orbital infections

OBJECTIVES: To evaluate the association between corticosteroid use and clinical outcomes in children hospitalised with severe orbital infections, and to describe practice patterns of systemic corticosteroid use. DESIGN: Multi-site observational cohort study using hospital data from 2009 to 2018. SETTING: Canadian children's hospitals (7) and community hospitals (3). PATIENTS: Children 2 months and 18 years hospitalised with severe orbital infections. INTERVENTIONS: Systemic corticosteroids at any time MAIN OUTCOME MEASURES: Length of hospital stay and surgical intervention using time-to-event Cox proportional hazards multivariable regression models to account for potential differences in timing of corticosteroid use (early, ≤24 hours or late, >24 hours after admission), with adjustment for covariates. RESULTS: Of the 1479 hospitalised children, 876 (59.2%) were male and median age was 5.3 years (IQR 2.2 to 9.8). Of the 65 (4.4%) who received corticosteroids, over half (53.8%) received them early. Median length of stay was 75.9 hours (IQR 47.1 to 130.4) and 98 (6.6%) underwent surgical intervention. Corticosteroid use was associated with delayed discharge and prolonged hospitalisation, as reflected by a HR of 0.73 (95% CI 0.55 to 0.96) in adjusted analyses. However, systemic corticosteroids had no association with surgical intervention (HR 0.82, 95% CI 0.36 to 1.88). CONCLUSION: In a large cohort of hospitalised children with severe orbital infections, corticosteroids were used infrequently, and when used, were not associated with improved clinical outcomes. Further high-quality trial evidence is needed to determine if routine corticosteroids are safe and effective.