Moreddu Eric, Rossi Marie-Eva, Bellal Dalia, Alshawareb Fadi, Nicollas Richard, Qarbal Jawad
Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, APHM, Aix-Marseille Univ, Marseille, France.
Otorhinolaryngology-Head & Neck Surgery, Avignon Hospital Center, Avignon, Provence-Alpes-Côte d'Azu, France.
J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251349444. doi: 10.1177/19160216251349444. Epub 2025 Jul 13.
ObjectiveTo identify reliable clinical, biological, and radiological markers predicting the failure of medical treatment in pediatric patients with acute ethmoidal rhinosinusitis (AERS) and subperiosteal abscess, facilitating informed decisions regarding the need for surgical intervention.DesignRetrospective multicenter cohort study.SettingPediatric otorhinolaryngology departments at a tertiary-care center and a public hospital in France, spanning from January 2014 to January 2024.ParticipantsChildren under 18 years diagnosed with Chandler stage III orbital complication of AERS, confirmed by computed tomography (CT).InterventionsInitial treatment with antibiotics, with surgical intervention as required based on clinical evaluation.Main Outcome MeasuresFactors associated with the need for surgical intervention, including demographic data, clinical examination, C-reactive protein (CRP) levels, leukocyte count, and CT evaluation.ResultsOut of 65 patients, 31 (48%) underwent surgery and 34 (52%) were treated with antibiotics alone. In multivariate analysis adjusted for age, the significant factors associated with surgical intervention included complete eyelid closure (odds ratio (OR) = 7.6; < .001), ophthalmoplegia (OR = 14.2; < .001), clinical exophthalmos (OR = 25.0; < .001), CRP level >60 mg/L (OR = 6.9; = .006), leukocyte count >15,600 g/L (OR = 7.7; = .002), radiological exophthalmos (OR = 6.1; = .001), retro-septal cellulitis (OR = 3.5; = .02), posterior ethmoid opacification (OR = 6.1; = .03), and abscess width >4 mm (OR = 8.2; = .01).Conclusions and RelevanceMany patients can be managed medically. However, complete eyelid closure should prompt a CT scan. Exophthalmos, retro-septal cellulitis, or an abscess wider than 4 mm is an indication for surgical drainage. Ophthalmoplegia should be interpreted in context. CRP level >60 mg/L, a leukocyte count >15,600 g/L, and posterior ethmoid opacification should lead to close monitoring. These findings can aid in developing a clinico-bio-radiological score to guide treatment decisions, potentially improving patient outcomes by standardizing care protocols.
目的
识别可靠的临床、生物学和放射学标志物，以预测小儿急性筛窦鼻窦炎（AERS）合并骨膜下脓肿患者内科治疗的失败情况，从而为是否需要手术干预提供明智的决策依据。
设计
回顾性多中心队列研究。
背景
法国一家三级医疗中心和一家公立医院的儿科耳鼻喉科，时间跨度为2014年1月至2024年1月。
参与者
18岁以下被诊断为AERS Chandler III期眼眶并发症且经计算机断层扫描（CT）确诊的儿童。
干预措施
初始采用抗生素治疗，根据临床评估必要时进行手术干预。
主要观察指标
与手术干预需求相关的因素，包括人口统计学数据、临床检查、C反应蛋白（CRP）水平、白细胞计数和CT评估。
结果
65例患者中，31例（48%）接受了手术，34例（52%）仅接受了抗生素治疗。在根据年龄进行调整的多变量分析中，与手术干预相关的显著因素包括完全眼睑闭合（比值比（OR）=7.6；<0.001）、眼肌麻痹（OR = 14.2；<0.001）、临床眼球突出（OR = 25.0；<0.001）、CRP水平>60mg/L（OR = 6.9；= 0.006）、白细胞计数>15,600g/L（OR = 7.7；= 0.002）、放射学眼球突出（OR = 6.1；= 0.001）、鼻中隔后蜂窝织炎（OR = 3.5；= 0.02）、后筛窦混浊（OR = 6.1；= 0.03）以及脓肿宽度>4mm（OR = 8.2；= 0.01）。
结论及相关性
许多患者可通过内科治疗。然而，完全眼睑闭合应促使进行CT扫描。眼球突出、鼻中隔后蜂窝织炎或脓肿宽度大于4mm是手术引流的指征。眼肌麻痹应结合具体情况解读。CRP水平>60mg/L、白细胞计数>15,600g/L以及后筛窦混浊应密切监测。这些发现有助于制定临床 - 生物学 - 放射学评分以指导治疗决策，可能通过规范护理方案改善患者预后。
