Related Experiment Video
Updated: Aug 1, 2025
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Variation in the Management of Hospitalized Children With Orbital Cellulitis Over 10 Years
Emily Lan-Vy Nguyen1, Leo Hersi1, Sanjay Mahant1,2,3,4
1The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study reveals significant variations in how hospitalized children with orbital cellulitis are treated across Canadian hospitals. Diagnostic test use and medical interventions increased over time, but surgical rates and hospital stays remained largely unchanged.
Area of Science:
- Pediatric infectious diseases
- Ophthalmology
- Hospital management
Background:
- Orbital cellulitis is a serious pediatric infection requiring prompt management.
- Previous studies have not comprehensively analyzed management variations for pediatric orbital cellulitis across diverse hospital settings in Canada.
- Understanding these variations is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To examine variations and trends in the management of hospitalized children with orbital cellulitis across Canadian children's and community hospitals.
- To investigate differences in diagnostic testing, imaging, antibiotic use, adjunctive therapies, and surgical interventions.
- To assess the association between clinical management strategies and patient outcomes, specifically length of hospital stay.
Main Methods:
- A multicenter cohort study involving 1579 children (2 months to 18 years) diagnosed with orbital cellulitis between 2009 and 2018.
- Data were collected from 10 hospitals across Canada, including children's and community hospitals.
- Statistical analyses, including chi-squared tests, Mann-Whitney U tests, Kruskal-Wallis tests, and median regression, were used to assess variations and associations.
Main Results:
- Significant hospital-level variations were observed in the utilization of C-reactive protein tests, CT scans, MRI scans, and various intranasal and systemic corticosteroid treatments.
- Children's hospitals showed higher usage of certain diagnostic tests and adjunctive agents compared to community hospitals.
- From 2009 to 2018, there was a notable increase in C-reactive protein test usage and a decrease in erythrocyte sedimentation rate, alongside an overall rise in medical intervention rates.
Conclusions:
- Significant variations exist in the diagnostic and treatment approaches for pediatric orbital cellulitis across Canadian hospitals.
- Increased utilization of diagnostic tests and medical interventions over time did not correlate with significant changes in surgical intervention rates or length of hospital stay.
- Further research is needed to understand the clinical impact of these management variations and to standardize care protocols for better patient outcomes.
Objectives:
No previous study has examined the management of hospitalized children with orbital cellulitis at both children's and community hospitals across multiple sites in Canada. We describe variation and trends over time in diagnostic testing and imaging, adjunctive agents, empiric antibiotics, and surgical intervention in children hospitalized with orbital cellulitis.
Patients And Methods:
Multicenter cohort study of 1579 children aged 2 months to 18 years with orbital cellulitis infections admitted to 10 hospitals from 2009 to 2018. We assessed hospital-level variation in the use of diagnostic tests, imaging, antibiotics, adjunctive agents, surgical intervention, and clinical outcomes using X2, Mann-Whitney U, and Kruskal-Wallis tests. The association between clinical management and length of stay was evaluated with median regression analysis with hospital as a fixed effect.
Results:
There were significant differences between children's hospitals in usage of C-reactive protein tests (P < .001), computed tomography scans (P = .004), MRI scans (P = .003), intranasal decongestants (P < .001), intranasal corticosteroids (P < .001), intranasal saline spray (P < .001), and systemic corticosteroids (P < .001). Children's hospital patients had significantly longer length of hospital stay compared with community hospitals (P = .001). After adjustment, diagnostic testing, imaging, and subspecialty consults were associated with longer median length of hospital stay at children's hospitals. From 2009 to 2018, C-reactive protein test usage increased from 28.8% to 73.5% (P < .001), whereas erythrocyte sedimentation rate decreased from 31.5% to 14.1% (P < .001).
Conclusions:
There was significant variation in diagnostic test usage and treatments, and increases in test usage and medical intervention rates over time despite minimal changes in surgical interventions and length of stay.
Related Concept Videos
01:26Tonsillitis II: Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: