Reducing pediatric facial cellulitis of odontogenic origin related hospital admissions using an ambulatory protocol

To investigate the impact of implementing an Ambulatory Protocol for Dental Abscess and Facial Cellulitis (APD) on hospital admissions for pediatric patients with facial cellulitis of odontogenic origin (FCOO). Additionally, we explored the potential relationships of patient and oral health factors on admission status.

A retrospective chart review was completed for all patients who presented to the emergency department (ED) at The Hospital for Sick Children (SickKids) with FCOO between January 1, 2011, and December 31, 2018. Treatment pathways were recorded as hospital admission, ambulatory treatment, or immediate treatment in the ED. Associations between patient demographic and oral health factors, and admission status were statistically analyzed.

A total of 452 children (0-18 years) were included in this study. A significant difference in proportions was observed between FCOO-related hospital admission and pre- versus post-APD implementation (X² = 32.53, p < 0.001). Patients treated post-APD implementation had 62 % lower odds of admission (OR: 0.38, 95 % CI: 0.25-0.58). Age was the only significant interaction term. Older patients had 20 % greater odds of admission for each additional year of age post-APD (OR: 1.20, 95 % CI: 1.04-1.38). In the improved model with the interaction term, patients had 88 % lower odds of admission (OR: 0.12, 95 % CI: 0.05-0.32) post-APD. Primary maxillary first molars were most associated with FCOO, FCOO-related admissions, and these cases had 72 % lower odds of admission post-APD (OR: 0.28, 95 % CI: 0.13-0.58).

Improving access to ambulatory services, such as through SickKids' APD, was associated with decreased FCOO-related admissions.