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Evaluation of moderate periorbital cellulitis and home-based therapy in children (EPOCH study, Part 2): A prospective
Zachary McPherson1,2, Deepali Thosar1, Amie Donnelly3
1Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Insights
Ambulatory care is a safe and effective strategy for moderate paediatric periorbital cellulitis, reducing hospital admissions. This approach allows children to receive intravenous antibiotics at home, improving community-based care.
Area of Science:
- Ophthalmology
- Pediatric Emergency Medicine
- Infectious Diseases
Background:
- Paediatric periorbital cellulitis often necessitates inpatient care for intravenous antibiotics due to concerns of orbital spread.
- Current management strategies for moderate periorbital cellulitis typically involve hospital admission.
Purpose of the Study:
- To evaluate the safety and efficacy of an ambulatory care model for managing children with moderate periorbital cellulitis.
- To assess the feasibility of outpatient management for this condition.
Main Methods:
- A prospective study enrolled 84 children (aged 1-16 years) with moderate periorbital cellulitis.
- Eligible children received intravenous antibiotics and were discharged with a peripheral cannula for ambulatory care follow-up.
- Descriptive statistics were used to analyze demographic and clinical data.
Main Results:
- 62 out of 84 children (73.8%) were successfully managed via the ambulatory care pathway.
- Children managed as inpatients did not show higher CRP or White Cell counts compared to those managed in ambulatory care.
- Two children required inpatient admission due to deterioration; one needed ophthalmic surgery. No mortality or sight-threatening complications occurred.
Conclusions:
- A dedicated ambulatory care pathway is a safe and effective strategy for moderate paediatric periorbital cellulitis.
- This approach reduces hospital bed occupancy and facilitates community-based patient management.
- Ambulatory care can be a viable alternative to inpatient admission for selected pediatric patients.
Background:
Paediatric periorbital cellulitis, a common eye condition, typically requires inpatient admission for intravenous antibiotics due to concerns about orbital spread. This study aimed to assess the safety and effectiveness of ambulatory management for children with moderate periorbital cellulitis.
Methods:
Over a 24-month period, we prospectively enrolled 84 children aged 1 to 16 years who presented with moderate periorbital cellulitis to the emergency department. Demographic and clinical data were collected. Following a guideline-based decision tree, eligible children received intravenous antibiotics and were discharged with a peripheral cannula for follow-up in ambulatory care and ophthalmology clinics. Descriptive statistics were used for data presentation.
Results:
Among the 84 children, 62 (73.8%) were managed through the ambulatory care model. Within the category of moderate POC, those who were admitted to the hospital did not have higher CRP or White Cell counts and received IV antibiotics for the same length of time. The ambulatory care clinic provided a total of 132 daily doses of intravenous antibiotics. Two children treated on this pathway required inpatient admission due to clinical deterioration, one of whom required ophthalmic surgical intervention. There was no mortality or sight-threatening complications in this study.
Conclusions:
Implementing a directed ambulatory care pathway for children with moderate periorbital cellulitis proved to be an effective and safe management strategy. This approach reduces the strain on hospital bed occupancy while promoting community-based patient care.
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