Article
The management of periorbital cellulitis in a welsh district General Hospital
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Published: | April 11, 2016 |
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Outline
Abstract
Introduction: Periorbital cellulitis is a common ENT emergency that requires prompt diagnosis, management and multidisciplinary team input. The challenge of correlating the clinical picture with the extent of disease, the absence of Clinical Guidelines and frequent handover within firms, can lead to delays in radiological and surgical intervention. We aim to review the management of periorbital cellulitis in our department, perform a literature review and discuss whether a clinical guideline would be of practical benefit.
Method: A retrospective study of all patients with periorbital cellulitis admitted to Wrexham Maelor Hospital from October 2011 to October 2014. All clinical notes coded with a diagnosis of periorbital cellulitis were reviewed and the population statistics and patient management details noted.
Results: 35 patients were diagnosed over this period, 34 notes were reviewed (N=34). M:F ratio 1:1.3, 26 of patients were <18 year old. The average length of stay was 5.24 days.
Presenting complaints included eye swelling (88%), pain (53%) and erythema (29%). 32 had ophthalmology review, 10 of which were assessed >24 hours after admission. A CT scan was performed in 24% of patients, 33% of scans showed intraorbital infection and in 17% a collection, 12% of these cases underwent surgical management. 20.5% of patients had no ENT input. 14 combinations of antibiotics were used.
Conclusions: This audit revealed a lack of consistency in the management of periorbital cellulitis. A clinical guideline with input from ophthalmology, radiology and microbiology would be useful, especially for juniors unfamiliar with the speciality, in the aim to establish consistent safe patient care without delay.
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