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PERIORBITAL CELLULITIS: AMBULATORY CARE THAT IS SAFE AND COST EFFECTIVE
  1. E J Yule,
  2. J Fryer,
  3. J Ross
  1. Paediatric Emergency Department, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom

Abstract

Objectives & Background Increasing ambulatory care is a goal of the College of Emergency Medicine. It reduces burden on inpatient wards, and is well received by patients and parents. Ambulatory care of children with periorbital cellulitis is not universally accepted, and warrants evaluation.

Methods We reviewed all patients less than 16 years old diagnosed with periorbital cellulitis in a paediatric emergency department (PED) between April 2009 and April 2013. We identified the treatment received, length of stay in those admitted and number of visits to the ED in those ambulated. We compared each year since 2009 (when ambulation was written into local guidelines) looking at treatment given and patient outcomes. We calculated an estimated cost of care for each case using local tariffs.

Results 353 cases were identified. 63 (17.8%) were admitted from first assessment. 194 (54.9%) received ambulatory intravenous antibiotics, of those 5 (1.4%) were subsequently admitted. No children who received ambulatory care developed a significant complication e.g. orbital cellulitis. Comparison of the first and last 12 months demonstrated a falling admission rate from 32.9% to 10.3% (p<0.05). During the same period ambulatory intravenous antibiotic use rose from 32.9% to 67.9% (p<0.05). There was a reduction in initial treatment with oral antibiotics (31.2% to 21.8% p>0.05). This is a less significant trend but has important implications considering the morbidity and patient/parent acceptability of cannulation. We estimate an average saving of £2,420 per patient ambulated.

Conclusion Ambulatory care of periorbital cellulitis is safe and cost effective, with very low rate of complication. We postulate that the availability of ambulatory intravenous antibiotics may be affecting clinical decision making, resulting in more children with mild periorbital cellulitis receiving intravenous rather than oral antibiotics. We suggest there is a role for developing a periorbital cellulitis scoring system to assess severity and guide treatment.

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Periorbital Cellulitis.

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