Background Due to limited evidence to guide management of periorbital cellulitis (POC), we surveyed current practice and assessed quality and consistency of local clinical practice guidelines (CPGs) to highlight future research priorities.
Methods A web-based survey was sent to a designated emergency physician (who clinically assesses children) at Paediatric Emergency Research United Kingdom and Ireland (PERUKI) sites between 23 November 2018 to 22 January 2019. A nominated site lead offered one response as a department-wide perspective on admission, severity assessment, treatment, disposition and specialty consultation request. Sites shared their CPG. These were compared using a standardised data collection tool, and quality assessed using Standardised Reporting Practice Guidelines in Healthcare (RIGHT) criteria. Survey responses were also compared against CPG recommendations.
Results 83% (49/59) institutions invited submitted an individual survey response. 67% of responding sites had a CPG and 63% (31/49) submitted these. CPG quality was poor (mean 6.7/35 RIGHT criteria). 21 different severity markers were identified across CPGs. Most CPGS recommend investigations for severe disease, yet 23% (7/31) advise blood culture universally. 90% of CPGs advise discharge with oral antibiotics for milder cases, yet 86% of respondents reported departmental admission of all patients with POC. Nearly all respondents included proptosis, systemically unwell and visual disturbance as indications for admission but differed regarding importance of other signs.
Conclusions We demonstrated variation in practice across the PERUKI network in assessment of severity and management of POC. CPGs vary in recommendations, and clinical practice appears to differ from CPGs. Guidelines were generally of poor quality when compared against RIGHT standards.
- pediatric emergency medicine
Data availability statement
Data are available on reasonable request. Any further data required may be made available via request to the corresponding author.
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Handling editor Shammi L Ramlakhan
Twitter @merieltc, @adamsonjon, @mdlyttle, @damian_roland
Contributors Conceptualised and led study: MT-C. Contributed to the design of the study: all authors. Developed the survey: MT-C, JE. Analysed the survey data: MT-C. Analysed the clinical practice guidelines: MT-C, JE, TW. Drafted the manuscript: MT-C, JE, TW, RM, JA. Critically reviewed the manuscript and contributed to its revision: DR, MDL. Supervised all aspects of the work: TW, DR, MDL. All authors approved the final manuscript and share accountability for the study as a whole.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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