71 Canadian practice patterns in the management of paediatric periorbital and orbital cellulitis: A national survey

Abstract Background Periorbital and orbital cellulitis are common infections in the paediatric population requiring interdisciplinary management. However, there are no Canadian clinical practice guidelines to evaluate and manage these severe orbital infections, and wide variation in care. Objectives To describe clinical practice patterns in admission, diagnostic tests, antibiotic therapy, subspecialty consultation, and discharge recommendations across Canadian hospitals. Design/Methods A cross-sectional survey of general paediatricians at children’s and community hospitals across Canada, and paediatric emergency department (ED) physicians at children’s hospitals was conducted. The survey was distributed through the Canadian Paediatric Inpatient Research Network (PIRN), and completed by one representative per hospital. Site-level clinical management specific to each provider type was assessed. Data were analyzed descriptively. Results Of 59 individuals contacted, 43 responded (72.9%) of which 19 (44.2%) were community hospital paediatricians, 13 (30.2%) were children’s hospitals paediatricians, and 11 (25.6%) were paediatric ED physicians. Only one hospital had a comprehensive clinical practice guideline. The most frequently ordered tests in the ED were CBC (81.9%) and CRP (81.9%). Abnormal vision and painful extra-ocular movements were indicators for admission. For admitted children, CT scans were ordered ‘always or frequently’ by 46.2% of children’s hospital paediatricians and 5.3% of community hospital paediatricians. Ophthalmology (n=11, 84.6%), otolaryngology (n=9, 69.2%), and infectious diseases (n=6, 46.2%) were frequently consulted at children’s hospitals. Patients with periorbital cellulitis who did not require admission were usually discharged home on oral cephalexin. Table 1 outlines antibiotic selections for admitted patients. Conclusion There is no consensus on diagnostic test usage, subspeciality consultation, and empiric antibiotic therapy for severe orbital infections. A Canadian clinical practice guideline is needed to help standardize management.