Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2010 Apr;125(4):e719-26. doi: 10.1542/peds.2009-1709. Epub 2010 Mar 1.
Computed tomography (CT) is used often in the evaluation of orbital infections to identify children who are most likely to benefit from surgical intervention. Our objective was to identify predictors for intraorbital or intracranial abscess among children who present with signs or symptoms of periorbital infection. These predictors could be used to better target patients for emergent CT.
This was a retrospective cohort study of all patients admitted to an urban pediatric tertiary care emergency department between 1995 and 2008. We included otherwise healthy patients with suspected acute clinical periorbital or orbital cellulitis without a history of craniofacial surgery, trauma, or external source of infection. Immunocompromised patients and patients with noninfectious causes of periorbital swelling were excluded. Variables analyzed included age, duration of symptoms, highest recorded temperature, previous antibiotic therapy, physical examination findings, laboratory results, and interpretation of imaging. CT scans of the orbit were reread by a neuroradiologist.
Nine hundred eighteen patients were included; 298 underwent a CT scan, and of those, 111 were shown to have an abscess. Although proptosis, pain with external ocular movement, and ophthalmoplegia were associated with presence of an abscess, 56 (50.5%) patients with abscess did not experience these symptoms. Other variables associated with the presence of an abscess in multivariate analysis were a peripheral blood neutrophil count greater than 10,000/microL, absence of infectious conjunctivitis, periorbital edema, age greater than 3 years, and previous antibiotic therapy (P < .05 for all). Our recursive partitioning model identified all high-risk (44%) patients as well as a low-risk (0.4%-2%) group (Rsq = 0.27).
We confirmed that patients with proptosis and/or pain or limitation of extraocular movements are at high risk for intraorbital abscess, yet many do not have these predictors. Other features can identify patients who do not have such obvious predictors but do have significant risk of disease. A recursive partitioning model is presented.
计算机断层扫描（CT）常用于评估眼眶感染，以确定最有可能从手术干预中获益的儿童。我们的目的是确定有眼眶或颅内脓肿表现的儿童中，有哪些预测指标。这些预测指标可用于更好地针对有紧急 CT 适应证的患者。
这是一项回顾性队列研究，纳入了 1995 年至 2008 年间在城市儿科三级保健急诊部就诊的所有患者。纳入标准为疑似急性眶周或眼眶蜂窝织炎但无头面部手术、创伤或外源性感染史的健康患儿。排除免疫功能低下的患者和眶周肿胀的非感染性病因患者。分析的变量包括年龄、症状持续时间、最高记录体温、先前的抗生素治疗、体格检查结果、实验室结果和影像学解读。由神经放射科医生对眼眶 CT 进行重新解读。
共纳入 918 例患者，其中 298 例行 CT 检查，111 例显示有脓肿。虽然眼球突出、眼球运动时疼痛和眼肌麻痹与脓肿存在有关，但 56 例（50.5%）脓肿患者无上述症状。多变量分析中与脓肿存在相关的其他变量包括外周血中性粒细胞计数＞10000/μL、无传染性结膜炎、眶周水肿、年龄＞3 岁和先前的抗生素治疗（所有 P 值＜0.05）。我们的递归分区模型识别出所有高风险（44%）患者和低风险（0.4%-2%）患者（Rsq = 0.27）。
我们证实眼球突出和/或疼痛或眼球运动受限的患者发生眼眶脓肿的风险高，但许多患者没有这些预测指标。其他特征可以识别出虽无明显预测指标但确实存在显著疾病风险的患者。本文提出了一种递归分区模型。
