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Prognostic Factors of Pediatric Acute Ethmoidal Rhinosinusitis With Orbital Subperiosteal Abscess: A Retrospective
Eric Moreddu1, Marie-Eva Rossi1, Dalia Bellal1
1Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, APHM, Aix-Marseille Univ, Marseille, France.
Insights
Clinical, biological, and radiological markers can predict treatment failure in pediatric acute ethmoidal rhinosinusitis (AERS) with subperiosteal abscess. Findings guide surgical intervention decisions, potentially improving outcomes.
Area of Science:
- Otorhinolaryngology
- Pediatric Ophthalmology
- Medical Imaging
Background:
- Acute ethmoidal rhinosinusitis (AERS) with orbital complications, such as subperiosteal abscess, requires careful management to prevent severe sequelae.
- Distinguishing between medical and surgical treatment needs in pediatric cases is crucial for optimal outcomes.
Purpose of the Study:
- To identify predictive clinical, biological, and radiological markers for medical treatment failure in pediatric AERS with subperiosteal abscess.
- To inform decisions regarding surgical intervention versus conservative medical management.
Main Methods:
- Retrospective multicenter cohort study of pediatric patients diagnosed with Chandler stage III orbital complication of AERS.
- Analysis of demographic data, clinical examination findings, C-reactive protein (CRP) levels, leukocyte count, and computed tomography (CT) findings.
- Multivariate analysis to determine factors associated with the need for surgical intervention.
Main Results:
- Of 65 patients, 48% required surgery. Significant predictors for surgery included complete eyelid closure, ophthalmoplegia, clinical and radiological exophthalmos, high CRP levels (>60 mg/L), elevated leukocyte count (>15,600/µL), retro-septal cellulitis, posterior ethmoid opacification, and abscess width >4 mm.
- Complete eyelid closure, exophthalmos, and abscess width >4 mm were strong indicators for surgical drainage.
Conclusions:
- While many pediatric AERS cases with orbital complications can be managed medically, specific clinical and radiological signs necessitate surgical intervention.
- Elevated CRP, leukocytosis, and posterior ethmoid opacification warrant close monitoring.
- Development of a clinico-bio-radiological score is proposed to standardize treatment decisions and improve patient care.
Abstract:
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; P < .001), ophthalmoplegia (OR = 14.2; P < .001), clinical exophthalmos (OR = 25.0; P < .001), CRP level >60 mg/L (OR = 6.9; P = .006), leukocyte count >15,600 g/L (OR = 7.7; P = .002), radiological exophthalmos (OR = 6.1; P = .001), retro-septal cellulitis (OR = 3.5; P = .02), posterior ethmoid opacification (OR = 6.1; P = .03), and abscess width >4 mm (OR = 8.2; P = .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.
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