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Orbital and periorbital infections: a national perspective
Aditya Mahalingam-Dhingra1, Lina Lander, Diego A Preciado
1Department of Economics, Yale University, New Haven, Connecticut, USA.
Insights
Pediatric orbital cellulitis affects many children, with surgery needed in 12.4%. Older age and diplopia predict surgical intervention, guiding better patient triage and resource use.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Health Services Research
Background:
- Orbital and periorbital infections in children are common causes of hospital admission.
- Understanding the epidemiology and predictors of surgical intervention is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To delineate the national epidemiologic features of pediatric orbital and periorbital infections.
- To identify key predictors associated with the need for surgical intervention in pediatric cases.
Main Methods:
- Analysis of the Kids' Inpatient Database, a large administrative data set.
- Inclusion of pediatric inpatient admissions diagnosed with orbital cellulitis.
- Logistic regression analysis to evaluate predictors of surgical intervention, examining demographic, socioeconomic, and clinical variables.
Main Results:
- A total of 5440 hospital admissions for pediatric orbital cellulitis were identified, with 12.4% undergoing surgery.
- Surgical patients were older (mean age 10.1 years) and had longer hospital stays (7.1 days) and higher costs ($41,009) compared to non-surgical patients.
- Predictors for surgical intervention included older age, male sex, emergency department admission, and the clinical sign of diplopia (OR, 6.3).
Conclusions:
- This national study provides insights into the management of pediatric orbital cellulitis.
- Older age, presentation with diplopia, and emergency department admission are significant predictors of surgical intervention.
- Identifying these predictors can aid in optimizing patient triage, potentially reducing hospital length of stay and healthcare costs while maintaining quality of care.
Objectives:
To describe the epidemiologic features of pediatric orbital and periorbital infections from a national perspective and to identify predictors of surgery.
Design:
Analysis of the Kids' Inpatient Database.
Setting:
Administrative data set.
Patients:
Pediatric inpatient admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of orbital cellulitis.
Main Outcome Measures:
Hospital admission, socioeconomic, and clinical variables were examined and predictors of surgical intervention were evaluated using logistic regression.
Results:
A total 5440 hospital admissions was noted for pediatric orbital cellulitis; of these, 672 patients (12.4%) underwent surgical intervention. Mean length of stay for all patients was 3.8 days; 90.4% were routinely discharged. Patients who had surgery were older, with a mean (SE) age of 10.1 (0.29) years compared with 6.1 (0.10) years for nonsurgical patients (P < .001). Surgical patients had a significantly longer mean hospital stay (7.1 vs 3.4 days, P < .001) and a higher mean cost of care ($41 009 vs $13 008, P < .001) compared with nonsurgical patients. Demographic predictors of surgical intervention included male sex, admitting characteristics, and hospital location. Except for sex, these variables remained significant in a multivariate model. Clinically, diplopia is a predictor of surgical intervention (odds ratio, 6.3; 95% confidence interval, 3.4-11.7).
Conclusions:
This study describes the medical and surgical management of pediatric orbital and periorbital infections from a national perspective. Predictors of surgical intervention include older age, presentation with diplopia, and hospital admission via the emergency department. Knowledge of these variables facilitates analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, ultimately reducing costs and lengths of stay while preserving quality of care.
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