Evaluation of the Role of Adjunctive Corticosteroids in the Management of Children Hospitalized with Orbital Cellulitis
Abstract
Purpose/Objectives
Orbital cellulitis is an infection of the orbit that can lead to rare, but life-altering
complications. Previous studies have suggested that corticosteroids may improve recovery in
patients with orbital cellulitis. However, no large, multicenter studies have examined the use
of systemic corticosteroids in children with orbital cellulitis. The objectives of this current
study are to describe systemic corticosteroid use and associated outcomes in a national cohort
of children hospitalized with orbital cellulitis.
Design/Methods
Using the Pediatric Health Information System, we performed a retrospective cohort
analysis of children aged 2 months to 18 years old hospitalized with orbital cellulitis from
2007 to 2014. Propensity score matching was performed to match children with orbital
cellulitis who did or did not receive systemic corticosteroids on relevant clinical and
demographic factors. Post-propensity score comparisons were performed using generalized
linear mixed-effects or conditional logistic regression modeling to assess for differences in
outcomes including length of stay (LOS), cost, intensive care unit (ICU) transfer, emergency
department (ED) revisits, and hospital readmissions between children who did or did not
receive corticosteroids.
Results
Of 2,963 children hospitalized with orbital cellulitis who met inclusion criteria, 587
(19.8 %) received systemic corticosteroids. In the matched cohort, there were 1,072 children
(536 pairs) representing 41 hospitals. In the matched cohort, the LOS (Adjusted Rate Ratio
(95 % CI): 1.08 (0.95-1.22), p=0.265) were similar but the costs were higher (1.21 (1.06
1.37), p=0.004) in children who received corticosteroids compared with those who did not
receive corticosteroids. Although not statistically significant, we observed a trend of higher
rates of 14- and 30-day readmissions among children receiving corticosteroids compared to
children who did not receive corticosteroids.
Conclusions
In this large multicenter study, children with orbital cellulitis who received systemic
corticosteroids had higher costs, but similar LOS. Additionally, we observed a trend toward
increased rates of readmissions among children who received systemic corticosteroids. Our
findings suggest that systemic corticosteroids may not significantly improve recovery in
children with orbital cellulitis. Future prospective studies are needed to more fully assess the
risks and benefits of utilizing systemic corticosteroids in the management of children with
orbital cellulitis.
Table of Contents
Introduction -- Review of the literature -- Methods and materials -- Results -- Discussion -- Conclusions -- Appendix A. Excluded Secondary Diagnoses -- Appendix B. Indications for 30-day ED revisits and Readmissions -- Appendix C. Antibiotic Classification Scheme -- Appendix D. Antibiotic Categorization
Degree
M.S.