Author(s)
Andrew Thomas MD
Jared Olson PharmD
Jeremy Meier MD
Laura Hodo MD
Affiliation(s)
University of Utah
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the current role of the otolaryngologist in the care of pediatric patients with preseptal and postseptal orbital infections and discuss the utility of otolaryngology consultation in these infections. Objectives: Multiple medical services are involved in managing orbital infections, without a clearly defined role of the otolaryngologist. Our aims were to determine the role of the otolaryngologist in the management of these infections, and the utility of otolaryngologist involvement by comparing differences in costs and outcomes of care. Study Design: Retrospective cohort. Methods: Children with orbital/periorbital infection 1/1/2015 to 12/30/2106 were identified through electronic data warehouse diagnostic codes. Clinical and financial data were extracted from the database. Additional data was abstracted by manual chart review, including patient/disease characteristics, otolaryngology involvement, and outcomes. Statistical significance was determined by Fisher's exact test (categorical variables) and two tailed unpaired t-test (continuous variables). Results: Total 105 patients identified; 57 preseptal and 48 orbital/postseptal infection. Otolaryngology involved in 83.7% postseptal versus 0% preseptal only (P <0.0001), and 93.1% postseptal abscess versus 64.3% postseptal cellulitis (p = 0.028). Sinusitis radiographically identified in 74% of patients with CT (70% with CT), and associated with orbital (OR 27.46; p<0.0001) versus preseptal disease. Eight patients had subperiosteal abscess surgery, all involving otolaryngology (0% 30 day return). For orbital cellulitis, otolaryngology involvement did not impact average total cost ($5018 vs $5045), length of stay (2.41 vs 2.43 days), or 30 day return (0%). Conclusions: Clinician perceived utility of otolaryngology in surgical management of orbital infection (100% involvement) is high, but is low for preseptal infections (0%) despite 43% sinusitis comorbidity. For medically managed patients, utility of otolaryngology involvement prior to considering surgery appears limited. Reducing ambiguity of consultant roles may improve the value and process of care.