Clinical Pathway for Child with Suspected Preseptal or Orbital Cellulitis
- Related Pathways
- Sepsis, ED, Inpatient, PICU
- Meningitis, Suspected, Age > 56 days
Concern for Sepsis
ED, Inpatient and PICU Sepsis Pathway
ED, Inpatient and PICU Sepsis Pathway
- Antibiotic Recommendations
- Consults
- Complications requiring escalation of care
- Sub-periosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Subdural empyema, brain abscess
Team Assessment
- History and Physical Exam
- Obtain clinical images for Epic Haiku or Canto
No Orbital Signs
Unclear Orbital Signs
Clear Orbital Signs
- Consult Ophthalmology
- Primary Care Providers
- ED and Inpatient Providers contact Ophtho Cnslt via Epic On-call Finder
Preseptal Cellulitis
Orbital Cellulitis
Discharge
Admit
- Antibiotic Recommendations
- PO Antibiotic Escalation
- Follow up PCP 24-72 hrs
- Antibiotic Recommendations
- Give 1st IV dose in ED
- IV access, labs not routinely indicated
- CT orbit, sinuses with IV contrast, sedation/NPO as indicated
- Antibiotic Recommendations
- Consult ophthalmology
- Other consults as indicated
Ophthalmology and ENT Attending to Review
Considerations for Surgical Management
Considerations for Surgical Management
Admit Inpatient
Admit OR for Surgical Drainage
- Admit PICU
- Altered mental status
- Sepsis
- Intracranial extension
- Consult ID, Neurosurgery
as indicated
Inpatient Care
Inpatient Care
- Antibiotic Recommendations
- Consult Ophthalmology and ID as indicated
- Antibiotic Recommendations
- Consult Ophthalmology
- Other consults as indicated
- Nasal therapies not routinely recommended
- Steroids per Ophthalmology and ENT
- Daily NPO not recommended unless at high risk for surgical intervention
Monitor Treatment Response
Monitor Treatment Response
More frequent exams as indicated, obtain images for Epic
Adequate Treatment Response
Inadequate Treatment Response After 36 hrs
Adequate Treatment Response
Inadequate Treatment Response After 36 hrs
- Improved clinical findings
- Improving fever curve
- Tolerating PO intake
- No improvement in clinical findings
- No improvement in fever curve
- Improved clinical findings
- Afebrile for 24 hrs
- Tolerating PO intake
New or worsening orbital signs
- Consider imaging
- Consult Ophthalmology and ID as indicated
- Consult ID
- Consider repeat imaging
- Reconsider Surgical Management
- Ophthalmology/ENT Attending Discussion
Discharge
Daily re-evaluation until
adequate improvement
adequate improvement
Discharge
Daily re-evaluation until
adequate improvement
adequate improvement
Follow-up Ophthalmology 24-72 hrs
Follow-up Ophthalmology 24-72 hrs
Evidence
- Intravenous Steroids with Antibiotics on Admission for Children With Orbital Cellulitis
- Subperiosteal Abscess of the Orbit: Evolving Pathogens and the Therapeutic Protocol
- Role of Oral Corticosteroids in Orbital Cellulitis
- Microbiology and Antibiotic Management of Orbital Cellulitis
- Orbital Cellulitis
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