Observational Study

. 2023 Aug:171:111629.

doi: 10.1016/j.ijporl.2023.111629. Epub 2023 Jul 8.

Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study

Morgyn F McKerlie¹, Nikolaus E Wolter², Sanjay Mahant³, Jessica Cichon⁴, Elysa Widjaja⁵, Olivier Drouin⁶, Catherine Pound⁷, Julie Quet⁷, Gita Wahi⁸, Ann Bayliss⁹, Gemma Vomiero¹⁰, Jessica L Foulds¹¹, Ronik Kanani¹², Mahmoud Sakran¹³, Anupam Sehgal¹⁴, Cornelia M Borkhoff³, Eleanor Pullenayegum¹⁵, Arun Reginald¹⁶, Patricia C Parkin³, Peter J Gill¹⁷; Periorbital and Orbital Cellulitis (POC); Multicentre Study Group and Canadian Pediatric Inpatient Research Network (PIRN)

Collaborators, Affiliations

Collaborators

Peter J Gill¹⁸, Eleanor Pullenayegum¹⁸, Patricia C Parkin¹⁸, Elysa Widjaja¹⁸, Arun Reginald¹⁸, Nikolaus E Wolter¹⁸, Sanjay Mahant¹⁸, Semipe Oni¹⁸, Rashid Anwar¹⁸, Jessica Cichon¹⁸, Olivier Drouin¹⁹, Hossam Louriachi¹⁹, Catherine Pound²⁰, Julie Quet²⁰, Carsten Krueger²⁰, Yipeng Ge²⁰, Nardin Kirolos²⁰, Gita Wahi²¹, Ashaka Patel²¹, Ann Bayliss²², Hardika Jasani²², Emily Kornelsen²², Gemma Vomiero²³, Ashton Chugh²³, Jessica L Foulds²⁴, Sandra Gouda²⁴, Ronik Kanani²⁵, Susan Akbaroghli²⁵, Anupam Sehgal²⁶, Morgyn F McKerlie²⁶, Peter J Gill, Olivier Drouin, Catherine Pound, Julie Quet, Gita Wahi, Ann Bayliss, Gemma Vomiero, Jessica Foulds, Ronik Kanani, Mahmoud Sakran, Anupam Sehgal, Sanjay Mahant

Affiliations

¹ Queens School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
² The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
³ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁵ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
⁶ Department of Pediatrics, Université de Montreal, Montreal, QC, Canada; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada.
⁷ Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
⁸ Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada.
⁹ Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, ON, Canada.
¹⁰ Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada.
¹¹ Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
¹² North York General Hospital, University of Toronto, Toronto, ON, Canada.
¹³ Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, ON, Canada; Research, Lakeridge Health, Oshawa, ON, Canada.
¹⁴ Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada.
¹⁵ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁶ The Hospital for Sick Children, Toronto, ON, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.
¹⁷ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: peter.gill@sickkids.ca.
¹⁸ Hospital for Sick Children, Toronto, ON, Canada.
¹⁹ CHU Sainte-Justine, Montreal, QC, Canada.
²⁰ Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
²¹ McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada.
²² Trillium Health Partners, Mississauga, ON, Canada.
²³ Alberta Children's Hospital, Calgary, AB, Canada.
²⁴ Stollery Children's Hospital, Edmonton, AB, Canada.
²⁵ North York General Hospital, Toronto, ON, Canada.
²⁶ Kingston Health Sciences Centre, Kingston, ON, Canada.

PMID: 37437497
DOI: 10.1016/j.ijporl.2023.111629

Observational Study

Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study

Morgyn F McKerlie et al. Int J Pediatr Otorhinolaryngol. 2023 Aug.

. 2023 Aug:171:111629.

doi: 10.1016/j.ijporl.2023.111629. Epub 2023 Jul 8.

Authors

Collaborators

Peter J Gill¹⁸, Eleanor Pullenayegum¹⁸, Patricia C Parkin¹⁸, Elysa Widjaja¹⁸, Arun Reginald¹⁸, Nikolaus E Wolter¹⁸, Sanjay Mahant¹⁸, Semipe Oni¹⁸, Rashid Anwar¹⁸, Jessica Cichon¹⁸, Olivier Drouin¹⁹, Hossam Louriachi¹⁹, Catherine Pound²⁰, Julie Quet²⁰, Carsten Krueger²⁰, Yipeng Ge²⁰, Nardin Kirolos²⁰, Gita Wahi²¹, Ashaka Patel²¹, Ann Bayliss²², Hardika Jasani²², Emily Kornelsen²², Gemma Vomiero²³, Ashton Chugh²³, Jessica L Foulds²⁴, Sandra Gouda²⁴, Ronik Kanani²⁵, Susan Akbaroghli²⁵, Anupam Sehgal²⁶, Morgyn F McKerlie²⁶, Peter J Gill, Olivier Drouin, Catherine Pound, Julie Quet, Gita Wahi, Ann Bayliss, Gemma Vomiero, Jessica Foulds, Ronik Kanani, Mahmoud Sakran, Anupam Sehgal, Sanjay Mahant

Affiliations

¹ Queens School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
² The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
³ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁵ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
⁶ Department of Pediatrics, Université de Montreal, Montreal, QC, Canada; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada.
⁷ Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
⁸ Department of Pediatrics, McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada.
⁹ Trillium Health Partners, Department of Paediatrics, University of Toronto, Mississauga, ON, Canada.
¹⁰ Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada.
¹¹ Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
¹² North York General Hospital, University of Toronto, Toronto, ON, Canada.
¹³ Department of Paediatrics, Queens University, Lakeridge Health, Oshawa, ON, Canada; Research, Lakeridge Health, Oshawa, ON, Canada.
¹⁴ Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada.
¹⁵ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁶ The Hospital for Sick Children, Toronto, ON, Canada; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada.
¹⁷ The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: peter.gill@sickkids.ca.
¹⁸ Hospital for Sick Children, Toronto, ON, Canada.
¹⁹ CHU Sainte-Justine, Montreal, QC, Canada.
²⁰ Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
²¹ McMaster University, McMaster Children's Hospital, Hamilton, ON, Canada.
²² Trillium Health Partners, Mississauga, ON, Canada.
²³ Alberta Children's Hospital, Calgary, AB, Canada.
²⁴ Stollery Children's Hospital, Edmonton, AB, Canada.
²⁵ North York General Hospital, Toronto, ON, Canada.
²⁶ Kingston Health Sciences Centre, Kingston, ON, Canada.

PMID: 37437497
DOI: 10.1016/j.ijporl.2023.111629

Abstract

Importance: Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage.

Objective: To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention.

Design: We conducted an observational cohort study using medical records from children hospitalized between 2009 and 2018.

Setting: Multicentre study using data from 6 children's hospitals.

Participants: Children were included if they were between 2 months and 18 years of age and hospitalized for an orbital infection with an abscess confirmed on cross-sectional imaging.

Exposure: Subperiosteal or orbital abscess volume.

Main outcome and measures: The primary outcome was surgical intervention, defined as subperiosteal and/or orbital abscess drainage. Multivariable logistic regression was performed to assess the association of abscess volume with surgery. To determine the optimal abscess volume cut-point, receiver operating characteristic (ROC) analysis was performed using the Youden Index to optimize sensitivity and specificity.

Results: Of the 150 participants (mean [SD] age, 8.5 [4.5] years), 68 (45.3%) underwent surgical intervention. On multivariable analysis, larger abscess volume and non-medial abscess location were associated with surgical intervention (abscess volume: adjusted odds ratio [aOR], 1.46; 95% CI, 1.11-1.93; abscess location: aOR, 3.46; 95% CI, 1.4-8.58). ROC analysis demonstrated an optimal abscess volume cut-point of 1.18 mL [AUC: 0.75 (95% CI 0.67-0.83) sensitivity: 66%; specificity: 79%]. CONCLUSIONS AND RELEVANCE: In this multicentre cohort study of 150 children with subperiosteal or orbital abscess, larger abscess volume and non-medial abscess location were significant predictors of surgical intervention. Children with abscesses >1.18 mL should be considered for surgery.

Keywords: Observational study; Orbital cellulitis; Pediatrics; Periorbital cellulitis.

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Conflict of interest statement

Declaration of competing interest PJG has received grants from the Canadian Institutes of Health Research (CIHR), the PSI Foundation, and The Hospital for Sick Children. He has received nonfinancial support from the EBMLive Steering Committee (expenses reimbursed to attend conferences) and the CIHRInstitute of Human Development, Child and Youth Health (as a member of the institute advisory board, expenses reimbursed to attend meetings). He is a member of the CMAJ Open and BMJ Evidence Based Medicine Editorial Board. PCP has received grants from the Hospital for Sick ChildrenFoundation (SP05-602), Canadian Institutes of Health Research (FRN # 115059), and non-financial support for an investigator-initiated trial for which Mead Johnson Nutrition provides non-financial support (Fer-In-Sol® liquid iron supplement) (2011–2017). OD was supported by a Chercheur Boursier Clinicien Award, from the Fonds de recherche du Québec – Santé. GW has received grants from the Canadian Institutes of Health Research and the Hamilton Health SciencesFoundation.

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Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study

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Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study

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