The Impact of Evidence Based Guidelines on Pediatric Orbital Cellulitis Management and Outcomes

Abstract

Purpose : Orbital cellulitis is a potentially sight-threatening infection of the soft tissues of the orbit. The Guidelines for Management of Pediatric Orbital Cellulitis were developed in 2014 with the goal of consolidating management recommendations regarding appropriate antimicrobial stewardship through local culture data and recommendations for use of adjunctive therapies.

Methods : A retrospective chart review was conducted on pediatric patients diagnosed with imaging confirmed orbital cellulitis prior to guideline deployment (2009-2013, n = 46) and post guideline deployment (2014-2021, n = 74). Data was collected on patient age and sex, interventions such as initial inpatient antibiotics, use of nasal care regimen (oxymetazoline/nasal saline/fluticasone nasal), use of systemic steroids, incidence of surgical intervention, as well as outcome measures such as incidence of readmission and length of stay. A chi-square test of independence and unpaired t-test were used to assess changes in management and patient outcomes before and after guideline implementation. A Bonferroni correction was applied to all statistical analyses.

Results : A chi-square test of independence showed a significant association between guideline implementation and appropriate initial inpatient antibiotic selection, X² (1, N = 120) = 7.56, p = .005. There was no significant association between guideline implementation and incidence of use of nasal care regimen X² (1, N = 120) = 2.82, p = .093, guideline implementation and incidence of use of systemic steroids X² (1, N = 120) = 0.07, p = .787, guideline implementation and occurrence of surgical intervention X² (1, N = 120) = 0.03, p = .847, or guideline implementation and incidence of readmission X² (1, N = 120) = 0.49, p = .482. Furthermore, an unpaired t-test revealed no significant difference in length of stay for patients treated before (M = 4.98; SD = 2.85) and after (M = 4.80; SD = 2.23) guideline implementation (t (118) = 0.39; p = .698).

Conclusions : The implementation of evidence-based guidelines for management of pediatric orbital cellulitis was successful in shifting physician behavior towards the use of appropriate initial inpatient antibiotics. However, this did not result in a significant change in outcome measures such as length of stay or readmission rate.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.