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

Morgyn F McKerlie; Nikolaus E Wolter; Sanjay Mahant; Jessica Cichon; Elysa Widjaja; Olivier Drouin; Catherine Pound; Julie Quet; Gita Wahi; Ann Bayliss; Gemma Vomiero; Jessica L Foulds; Ronik Kanani; Mahmoud Sakran; Anupam Sehgal; Cornelia M Borkhoff; Eleanor Pullenayegum; Arun Reginald; Patricia C Parkin; Peter J Gill; Periorbital and Orbital Cellulitis (POC); Multicentre Study Group and Canadian Pediatric Inpatient Research Network (PIRN)

doi:10.1016/j.ijporl.2023.111629

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

Int J Pediatr Otorhinolaryngol. 2023 Aug:171:111629. doi: 10.1016/j.ijporl.2023.111629. Epub 2023 Jul 8.

Authors

Morgyn F McKerlie¹, Nikolaus E Wolter², Sanjay Mahant³, Jessica Cichon⁴, Elysa Widjaja⁵, Olivier Drouin⁶, Catherine Pound⁷, Julie Quet⁷, Gita Wahi⁸, Ann Bayliss⁹, Gemma Vomiero¹⁰, Jessica L Foulds¹¹, Ronik Kanani¹², Mahmoud Sakran¹³, Anupam Sehgal¹⁴, Cornelia M Borkhoff³, Eleanor Pullenayegum¹⁵, Arun Reginald¹⁶, Patricia C Parkin³, Peter J Gill¹⁷; Periorbital and Orbital Cellulitis (POC); Multicentre Study Group and Canadian Pediatric Inpatient Research Network (PIRN)

Collaborators

Peter J Gill¹⁸, Eleanor Pullenayegum¹⁸, Patricia C Parkin¹⁸, Elysa Widjaja¹⁸, Arun Reginald¹⁸, Nikolaus E Wolter¹⁸, Sanjay Mahant¹⁸, Semipe Oni¹⁸, Rashid Anwar¹⁸, Jessica Cichon¹⁸, Olivier Drouin¹⁹, Hossam Louriachi¹⁹, Catherine Pound²⁰, Julie Quet²⁰, Carsten Krueger²⁰, Yipeng Ge²⁰, Nardin Kirolos²⁰, Gita Wahi²¹, Ashaka Patel²¹, Ann Bayliss²², Hardika Jasani²², Emily Kornelsen²², Gemma Vomiero²³, Ashton Chugh²³, Jessica L Foulds²⁴, Sandra Gouda²⁴, Ronik Kanani²⁵, Susan Akbaroghli²⁵, Anupam Sehgal²⁶, Morgyn F McKerlie²⁶, Peter J Gill, Olivier Drouin, Catherine Pound, Julie Quet, Gita Wahi, Ann Bayliss, Gemma Vomiero, Jessica Foulds, Ronik Kanani, Mahmoud Sakran, Anupam Sehgal, Sanjay Mahant

Affiliations

¹ Queens School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
² The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
³ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁵ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
⁶ Department of Pediatrics, Université de Montreal, Montreal, QC, Canada; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada.
⁷ Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
⁸ Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada.
⁹ Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, ON, Canada.
¹⁰ Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada.
¹¹ Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
¹² North York General Hospital, University of Toronto, Toronto, ON, Canada.
¹³ Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, ON, Canada; Research, Lakeridge Health, Oshawa, ON, Canada.
¹⁴ Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada.
¹⁵ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁶ The Hospital for Sick Children, Toronto, ON, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.
¹⁷ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].
¹⁸ Hospital for Sick Children, Toronto, ON, Canada.
¹⁹ CHU Sainte-Justine, Montreal, QC, Canada.
²⁰ Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
²¹ McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada.
²² Trillium Health Partners, Mississauga, ON, Canada.
²³ Alberta Children's Hospital, Calgary, AB, Canada.
²⁴ Stollery Children's Hospital, Edmonton, AB, Canada.
²⁵ North York General Hospital, Toronto, ON, Canada.
²⁶ Kingston Health Sciences Centre, Kingston, ON, Canada.

PMID: 37437497
DOI: 10.1016/j.ijporl.2023.111629

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.

Keywords: Observational study; Orbital cellulitis; Pediatrics; Periorbital cellulitis.

Publication types

Multicenter Study
Observational Study

MeSH terms

Abscess / surgery
Anti-Bacterial Agents / therapeutic use
Cellulitis
Child
Cohort Studies
Humans
Orbital Cellulitis* / drug therapy
Orbital Diseases* / surgery
Retrospective Studies
Tomography, X-Ray Computed

Substances

Anti-Bacterial Agents