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Management of intraorbital infections in the pediatric emergency department

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Abstract

Intraorbital infections may lead to severe complications, necessitating rapid diagnosis and intervention. The decision process regarding the need for emergent imaging and possible surgical intervention is unclear in the literature. This retrospective cohort study included two major pediatric emergency departments in Israel between 2010 and 2020. Patients arriving at the emergency department with an admission diagnosis of intraorbital infection and at least one high-risk symptom for orbital involvement were included in the study. The main outcome measures were the computerized tomography (CT) timing and results, whether the case was managed surgically or conservatively and whether the patient returned to the same hospital with significant complications. Ninety-five patients were included; 70 underwent a CT scan in the first 24 h, and of those 21 were managed surgically; 16 were treated based on clinical findings alone, with no imaging performed. When comparing groups based on management, we found no significant differences based on presenting symptoms, duration of complaints, or severity of CT findings. However, having three or more high-risk presenting symptoms was associated with a greater likelihood of surgical intervention (multivariate logistic regression p = 0.069, odds ratio 1.73, 95% confidence interval 0.96–3.11; one-way ANOVA and Fisher’s exact test p < 0.05).

Conclusion: The decision to treat intraorbital infections at our institutions appears to be based on clinical impression of disease severity rather than radiologic findings. This suggests a need for further interdisciplinary studies to clarify optimal management.

What is Known:

• Orbital c ellulitis is associated with significant potential complications, necessitating rapid diagnosis and treatment.

• Present literature provides insufficiently clear guidance on emergency department management.

What is New:

• Consideration of all relevant factors (clinical features, laboratory findings, timing of imaging, and conservative vs. surgical management) in a single retrospective cohort.

• Our findings suggest that decision-making in practice may be guided by clinical impression rather than imaging.

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Availability of data and material

Data is available upon request.

Code availability

N/A.

Abbreviations

ANC:

Absolute neutrophil count

CRP:

C-reactive protein

CT:

Computerized tomography

ED:

Emergency department

EMR:

Electronic medical records

IOI:

Intraorbital infection

OA:

Orbital abscess

OC:

Orbital cellulitis

SPA:

Subperiosteal abscess

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Authors and Affiliations

  1. Department of Pediatrics, Wilf Children’s Hospital, Shaare Zedek Medical Center, Jerusalem, Israel

    Michael Sorotzky & Avram R. Shack

  2. Pediatric Emergency Department, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

    Keren Shahar-Nissan & Ron Berant

  3. Pediatric Emergency Department, Wilf Children’s Hospital, Shaare Zedek Medical Center, 12 Shmuel Bait Street, 9103102, Jerusalem, Israel

    Giora Weiser, Elihay Berliner & Eyal Heiman

  4. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Giora Weiser, Elihay Berliner & Eyal Heiman

Authors
  1. Michael Sorotzky
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  2. Keren Shahar-Nissan
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  3. Avram R. Shack
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  4. Ron Berant
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  5. Giora Weiser
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  6. Elihay Berliner
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  7. Eyal Heiman
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Contributions

EH, GW, MS, and KSN designed the study. KSN and MS developed the study database. EB, RB, and ARS reviewed data analysis and results. All of the authors were involved in data collation and interpretation. GW and ARS drafted the original manuscript. All the authors contributed to and reviewed the final manuscript. All of the authors agree to the final manuscript. The corresponding author attests that all listed authors meet authorship criteria.

Corresponding author

Correspondence to Eyal Heiman.

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Ethics approval

This study has been approved by the hospital review board (Helsinki) SZMC-20–0170.

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Competing interests

The authors declare no competing interests.

Additional information

Communicated by Piet Leroy

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Sorotzky, M., Shahar-Nissan, K., Shack, A.R. et al. Management of intraorbital infections in the pediatric emergency department. Eur J Pediatr 181, 2741–2746 (2022). https://doi.org/10.1007/s00431-022-04468-x

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  • DOI: https://doi.org/10.1007/s00431-022-04468-x

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