Predictors of Surgical Intervention for Pediatric Acute Rhinosinusitis with Periorbital Infection

Area of Science:

• Otolaryngology
• Pediatric Infectious Diseases
• Ophthalmology

Background:

• Pediatric periorbital infections secondary to acute bacterial rhinosinusitis (ABRS) present a clinical management challenge.
• Determining the need for surgical drainage versus medical management is often complex.

Purpose of the Study:

• To identify prognostic factors associated with the requirement for surgical intervention in pediatric periorbital infections.
• To aid clinicians in making informed management decisions for these cases.

Main Methods:

• Retrospective review of 141 pediatric patients diagnosed with periorbital infection secondary to ABRS between 2001 and 2019.
• Data collected included demographics, clinical presentation, laboratory results, comorbidities, and CT findings.
• Multivariate logistic regression analysis was employed to identify significant predictors.

Main Results:

• 29.8% of patients (42/141) required surgical intervention.
• Delayed intravenous antibiotic initiation (>2 days) and initial proptosis were significantly associated with surgical need (OR=1.94, OR=6.63).
• C-reactive protein > 55.73 mg/L and delayed antibiotics showed strong predictive value for surgery.

Conclusions:

• Pediatric periorbital infections with delayed antibiotic treatment and presenting proptosis indicate a higher likelihood of requiring surgical intervention.
• These factors are associated with poorer patient outcomes, emphasizing the need for prompt management.