Murphy Declan C, Meghji Sheneen, Alfiky Mohamed, Bath Andrew P
Ear, Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
J Paediatr Child Health. 2021 Feb;57(2):227-233. doi: 10.1111/jpc.15179. Epub 2020 Sep 28.
To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis.
Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10-year period. Regression investigated correlations for continuous and categorical variables.
A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10-year period. Of these, 139 had pre-septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month-17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross-sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C-reactive protein was associated with greater risk of post-septal disease and requiring surgery. The best predictors of post-septal disease in the multivariate analysis (R = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R = 0.53, P = <0.001).
Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life-threatening or sight-threatening complications.
确定小儿眶周蜂窝织炎患者预后不良及需要手术治疗的预测因素。评估眶周蜂窝织炎管理中对当地指南的遵循情况。
对一家英国教学医院10年间175例小儿眶周蜂窝织炎病例的临床、实验室和影像学特征进行回顾性描述分析。回归分析研究连续变量和分类变量之间的相关性。
在这10年期间，共175例小儿病例被诊断为眶周感染。其中，139例为眶隔前蜂窝织炎，27例为骨膜下脓肿，6例为眶蜂窝织炎，1例为眶脓肿，1例为海绵窦血栓形成，1例为硬膜外脓肿。就诊时的中位年龄为5岁（范围：1个月至17岁）。总共169例（97%）病例接受了全身抗菌治疗。30%的病例进行了横断面成像，18%的病例需要手术干预。C反应蛋白升高与眶隔后疾病和需要手术的风险增加相关。多变量分析中眶隔后疾病的最佳预测因素（R = 0.49，P =≤0.001）是眼球运动麻痹（P = 0.009）、眼球突出（P = 0.016）和眼球运动时疼痛（P = 0.046）。眼球突出是手术治疗的唯一最显著预测因素（R = 0.53，P =<0.001）。
多学科参与和早期药物治疗可改善大多数患者的预后。尽管进行了药物治疗但病情仍恶化的患者应考虑及时进行影像学检查和手术治疗，以避免严重的危及生命或视力的并发症。
