Evaluation of the Role of Adjunctive Corticosteroids in the Management of Children Hospitalized with Orbital Cellulitis
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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