Older age, disease severity tied to treatment failure in children with orbital complications of ARS

In children admitted for orbital complications of acute rhinosinusitis (ARS), the most important causes of medical treatment failure are older age and stage II/III orbital complications at presentation, a recent study has shown.

“Early referral to eye, nose and throat (ENT) should be considered for children [aged] >5 years with ARS due to worse orbital complications despite prehospital antibiotics,” the authors said.

Two-thirds of the children had received antibiotics prior to hospital admission, but half of the cohort still presented with postseptal orbital complications. Eighty-three percent of isolates obtained from the same patients were susceptible to the prehospital antibiotics they received, but majority of these children still needed to undergo surgery.

A significant association existed between disease severity and the age of presentation. Despite prehospital antibiotics, more severe orbital complications occurred in children aged >5 years. This cohort was also more likely to require surgical intervention (p<0.001).

This retrospective cohort study characterized the clinical outcomes of 61 children admitted for orbital complications between 1 January 2002 and 31 December 2017 and identified risk factors associated with disease severity. The authors performed descriptive statistics to analyse the demographics and clinical findings. They also used Mann-Whitney U test for continuous variables and χ² for categorical variables to compare groups.

“The major clinical dilemma managing ARS in paediatric population is distinguishing uncomplicated rhinosinusitis from a complicated bacterial ARS and orbital complications, the latter requiring antimicrobials and surgical intervention,” the authors noted.