Fellow: Alice Lee, Pediatric Hospital Medicine Fellow, Baylor College of Medicine/Texas Children’s Hospital
Article: Markham, Jessica L., et al. “Variation in Care and Clinical Outcomes in Children Hospitalized with Orbital Cellulitis.” Hospital Pediatrics 2018; 8(1):28-35. doi: 10.1542/hpeds.2017-0040.
Summary: This was a multicenter, retrospective study that identified and described hospital-level variation in the care of orbital cellulitis and its relationship to patient outcomes. Data was derived from the Pediatric Health Information System (PHIS) database. It included children aged 2 months to 18 years old who were admitted to a PHIS-participating hospital from 2007-2014 with a primary ICD-9 discharge diagnosis code for orbital cellulitis (376.01). The study evaluated frequency of various diagnostic tests (labs and imaging), use of steroids, and antibiotic exposure within the first 2 days of hospitalization. Outcomes were length of stay, 30-day ED revisit rates, and 30-day readmission rates. There was significant variation in the length of stay but no significant variation across hospitals for 30-day ED revisits and 30-day readmission rates. Increased diagnostic test use correlated with increased length of stay but not with 30-day ED revisits or 30-day readmission rates.
Key Strengths: This was a large, multicenter study. It identified the majority of diagnostic tests and empiric antibiotic regimens used for orbital cellulitis.
Key Limitations: The PHIS database is limited to administrative data, which makes it difficult to associate patient presentation with clinical decision-making. The ICD-9 discharge code used includes periorbital cellulitis, orbital cellulitis, orbital abscess, and subperiosteal orbital abscess. The differences in management of preseptal vs postseptal cellulitis may lead to some of the variation in care seen in this study.
Major Takeaway: There is significant variation in the use of nearly every diagnostic test, use of corticosteroids, and choice of empiric antibiotics in the treatment of orbital cellulitis. The variation was seen between hospitals as well as within individual hospitals. The variation may reflect clinical uncertainty of the use of diagnostic tests or steroids to predict outcomes or varying expert opinion.
How this article should impact our practice: This study identifies a need for further investigation into the best ways to diagnose and manage orbital cellulitis. By doing so, there is opportunity for antimicrobial stewardship and the development of a clinical guideline.
Article: Markham, Jessica L., et al. “Variation in Care and Clinical Outcomes in Children Hospitalized with Orbital Cellulitis.” Hospital Pediatrics 2018; 8(1):28-35. doi: 10.1542/hpeds.2017-0040.
Summary: This was a multicenter, retrospective study that identified and described hospital-level variation in the care of orbital cellulitis and its relationship to patient outcomes. Data was derived from the Pediatric Health Information System (PHIS) database. It included children aged 2 months to 18 years old who were admitted to a PHIS-participating hospital from 2007-2014 with a primary ICD-9 discharge diagnosis code for orbital cellulitis (376.01). The study evaluated frequency of various diagnostic tests (labs and imaging), use of steroids, and antibiotic exposure within the first 2 days of hospitalization. Outcomes were length of stay, 30-day ED revisit rates, and 30-day readmission rates. There was significant variation in the length of stay but no significant variation across hospitals for 30-day ED revisits and 30-day readmission rates. Increased diagnostic test use correlated with increased length of stay but not with 30-day ED revisits or 30-day readmission rates.
Key Strengths: This was a large, multicenter study. It identified the majority of diagnostic tests and empiric antibiotic regimens used for orbital cellulitis.
Key Limitations: The PHIS database is limited to administrative data, which makes it difficult to associate patient presentation with clinical decision-making. The ICD-9 discharge code used includes periorbital cellulitis, orbital cellulitis, orbital abscess, and subperiosteal orbital abscess. The differences in management of preseptal vs postseptal cellulitis may lead to some of the variation in care seen in this study.
Major Takeaway: There is significant variation in the use of nearly every diagnostic test, use of corticosteroids, and choice of empiric antibiotics in the treatment of orbital cellulitis. The variation was seen between hospitals as well as within individual hospitals. The variation may reflect clinical uncertainty of the use of diagnostic tests or steroids to predict outcomes or varying expert opinion.
How this article should impact our practice: This study identifies a need for further investigation into the best ways to diagnose and manage orbital cellulitis. By doing so, there is opportunity for antimicrobial stewardship and the development of a clinical guideline.