Abscess volume as a predictor of surgical intervention in children hospitalized with orbital cellulitis: A multicentre cohort study

Orbital cellulitis with subperiosteal or orbital abscess can result in serious morbidity and mortality in children. Objective volume criterion measurement on cross-sectional imaging is a useful clinical tool to identify patients with abscess who may require surgical drainage. To determine the predictive value of abscess volume and the optimal volume cut-point for surgical intervention. We conducted an observational cohort study using medical records from children hospitalized between 2009 and 2018. Multicentre study using data from 6 children's hospitals. Children were included if they were between 2 months and 18 years of age and hospitalized for an orbital infection with an abscess confirmed on cross-sectional imaging. Subperiosteal or orbital abscess volume. The primary outcome was surgical intervention, defined as subperiosteal and/or orbital abscess drainage. Multivariable logistic regression was performed to assess the association of abscess volume with surgery. To determine the optimal abscess volume cut-point, receiver operating characteristic (ROC) analysis was performed using the Youden Index to optimize sensitivity and specificity. Of the 150 participants (mean [SD] age, 8.5 [4.5] years), 68 (45.3%) underwent surgical intervention. On multivariable analysis, larger abscess volume and non-medial abscess location were associated with surgical intervention (abscess volume: adjusted odds ratio [aOR], 1.46; 95% CI, 1.11–1.93; abscess location: aOR, 3.46; 95% CI, 1.4–8.58). ROC analysis demonstrated an optimal abscess volume cut-point of 1.18 mL [AUC: 0.75 (95% CI 0.67–0.83) sensitivity: 66%; specificity: 79%]. In this multicentre cohort study of 150 children with subperiosteal or orbital abscess, larger abscess volume and non-medial abscess location were significant predictors of surgical intervention. Children with abscesses >1.18 mL should be considered for surgery. •Orbital cellulitis complicated by subperiosteal or orbital abscess is a serious infection in children.•Objective volume criterion is a useful tool to identify patients who may require surgical drainage.•Abscess volume cut-points range from 0.5 mL to 3.8 mL reported in single centre studies.•In our heterogenous cohort, 1.18 mL was the optimal abscess cut-point.