5998 Audit of the management of paediatric orbital and pre-septal cellulitis and the role of specialist input in line with published guidelines

Objectives Orbital cellulitis is a serious bacterial infection, more commonly seen in the paediatric population and has the potential for serious long-term consequences if not managed appropriately.¹ However, management can be highly variable. This audit aimed to assess the compliance of management of orbital and pre-septal cellulitis with local and national guidelines (BIPOSA, Royal College of Ophthalmologists) by analysing clinical findings, treatment, specialist input and patient outcomes. Methods A retrospective analysis of 44 paediatric patients that presented to A&E with preseptal or orbital cellulitis between January 2020 and August 2022 was performed. Data was collected on IV antibiotic choice, timepoints of specialist ophthalmology and/or ENT input, length of hospital stay and total antibiotic regime following discharge. Results 29/44 patients were inpatients of which only 71% received the first line antibiotic as recommended by the local guidelines. There was great heterogeneity in time of IV antibiotic administration ranging from 30 minutes to 33 hours, and this was associated with increased length of hospital stay. 33% of patients did not receive any specialist input from ophthalmology or ENT, and 37% of inpatients were not followed up in an outpatient clinic. Conclusion Our results have highlighted the need to provide clear diagnostic criteria to distinguish between severe preseptal cellulitis and orbital cellulitis to ensure timely and appropriate management. Early specialist input and antibiotic administration is likely to reduce prolonged hospital stay and improve clinical outcomes for patients. We have revised current guidelines and updated them based on our findings, and will disseminate them within our department to improve compliance. Reference Danishyar A, Sergent SR. Orbital cellulitis. StarPearls. 2022. [Cited 2023 September 30]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507901/