Referral patterns in paediatric orbital cellulitis.
OBJECTIVE
Orbital cellulitis in children may result in severe visual morbidity and even mortality if not managed appropriately. The definitive management of orbital cellulitis is in the realms of the otolaryngologist, as the underlying pathology is associated with sinus disease in more than 90% of cases. Our observations suggest that there is a tendency for patients with suspected orbital cellulitis not to be referred promptly for otolaryngological opinion and management, which may result in adverse outcomes. The aim of this study was to determine the initial management by establishing general practitioners' attitudes to the referral and management of suspected orbital cellulitis.


METHODS
Anonymous questionnaires were sent to general practitioners to ascertain details on their initial treatment modalities and preferred specialist referral. General practitioners in Worcestershire and North Staffordshire, two major regions in the West Midlands, UK, were targeted.


RESULTS
The majority of general practitioners initially commenced patients on oral antibiotics, and referred patients primarily to ophthalmologists for further assessment, although significant variations in referral patterns were found.


CONCLUSIONS
Better education for primary care physicians is needed regarding the initial management and referral of paediatric patients with suspected orbital cellulitis. They should be referred promptly for hospital admission. A good multidisciplinary approach with quick involvement of the three specialities (ear, nose and throat, ophthalmology and paediatrics) would avoid delays in the definitive management and ensure optimal outcomes.
Kyprianou
Ioannis
I
Department of Otolaryngology and Head and Neck Surgery, Stoke on Trent, North Staffs ST4, UK.
D'Souza
Alwyn
A
Saravanappa
Natarajan
N
Lewis
Darren M
DM
Courtney-Harris
Roger
R
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002481:Cellulitis / Q000628:therapy*; D002648:Child; D004739:England; D006801:Humans; D009885:Ophthalmology / Q000706:statistics & numerical data; D009916:Orbital Diseases / Q000628:therapy*; D010372:Pediatrics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*
D000900:Anti-Bacterial Agents