TY - JOUR
T1 - Corticosteroids for acute orbital cellulitis
AU - Leszczynska, Maria Anna
AU - Sochet, Anthony Alexander
AU - Nguyen, Anh Thy H.
AU - Mateus, Jazmine
AU - Morrison, John Michael
N1 - Publisher Copyright:
© 2021 American Academy of Pediatrics. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - OBJECTIVES: Standard treatment of children hospitalized for acute orbital cellulitis includes systemic antibiotics. Recent data from single-center studies suggest the addition of systemic corticosteroids may hasten clinical improvement and reduce hospital length of stay (LOS). We investigate the potential relationship between corticosteroid exposure and duration of hospitalization for pediatric orbital cellulitis. METHODS: Using Pediatric Health Information System registry data from 51 children's facilities, we performed a retrospective cohort study of children hospitalized for orbital cellulitis <18 years of age from 2007 to 2018. The primary study outcome was hospital LOS. Secondary outcomes included frequency of surgical interventions, PICU admission, and 30-day relatedcause readmission. RESULTS: Of the 5645 children included for study, 1347 (24%) were prescribed corticosteroids within 2 days of admission. Corticosteroid prescription was not associated with LOS in analyses adjusted for age; presence of meningitis, abscess, or vision issues; and operative episode and PICU admission within 2 days (eb 5 1.01, 95% confidence interval [CI]: 0.97-1.06). Corticosteroid exposure was associated with operative episodes after 2 days of hospitalization (odds ratio 5 2.05, 95% CI: 1.29-3.27) and 30-day readmission (odds ratio 5 2.40, 95% CI: 1.52-3.78) among patients with a primary diagnosis of orbital cellulitis. CONCLUSIONS: In this database query, we were not able to detect a reduction in LOS associated with corticosteroid exposure during hospitalization for orbital cellulitis. Corticosteroid prescription was associated with PICU admission and operative episodes after 2 days of hospitalization. Before the adoption of routine corticosteroid use, prospective, randomized control trials are needed.
AB - OBJECTIVES: Standard treatment of children hospitalized for acute orbital cellulitis includes systemic antibiotics. Recent data from single-center studies suggest the addition of systemic corticosteroids may hasten clinical improvement and reduce hospital length of stay (LOS). We investigate the potential relationship between corticosteroid exposure and duration of hospitalization for pediatric orbital cellulitis. METHODS: Using Pediatric Health Information System registry data from 51 children's facilities, we performed a retrospective cohort study of children hospitalized for orbital cellulitis <18 years of age from 2007 to 2018. The primary study outcome was hospital LOS. Secondary outcomes included frequency of surgical interventions, PICU admission, and 30-day relatedcause readmission. RESULTS: Of the 5645 children included for study, 1347 (24%) were prescribed corticosteroids within 2 days of admission. Corticosteroid prescription was not associated with LOS in analyses adjusted for age; presence of meningitis, abscess, or vision issues; and operative episode and PICU admission within 2 days (eb 5 1.01, 95% confidence interval [CI]: 0.97-1.06). Corticosteroid exposure was associated with operative episodes after 2 days of hospitalization (odds ratio 5 2.05, 95% CI: 1.29-3.27) and 30-day readmission (odds ratio 5 2.40, 95% CI: 1.52-3.78) among patients with a primary diagnosis of orbital cellulitis. CONCLUSIONS: In this database query, we were not able to detect a reduction in LOS associated with corticosteroid exposure during hospitalization for orbital cellulitis. Corticosteroid prescription was associated with PICU admission and operative episodes after 2 days of hospitalization. Before the adoption of routine corticosteroid use, prospective, randomized control trials are needed.
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U2 - 10.1542/peds.2021-050677
DO - 10.1542/peds.2021-050677
M3 - Article
C2 - 34697218
AN - SCOPUS:85118792573
SN - 0031-4005
VL - 148
JO - Pediatrics
JF - Pediatrics
IS - 5
M1 - e2021050677
ER -