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Preseptal cellulitis versus orbital spectrum disease in children: Early predictors and impact on hospital costs.

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Τίτλος: Preseptal cellulitis versus orbital spectrum disease in children: Early predictors and impact on hospital costs.
Συγγραφείς: Demir E; Pediatric Health and Diseases Clinic of Goztepe Prof Dr. Suleyman Yalcin City Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: esmanur123@gmail.com., Hatipoglu N; Pediatric Health and Diseases Clinic of Bakirkoy Dr Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: naydin9@mynet.com., Sari EE; Pediatric Health and Diseases Clinic of Bakirkoy Dr Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: drergulsari@gmail.com., Hatipoglu SS; Pediatric Health and Diseases Clinic of Bakirkoy Dr Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: sahat55@gmail.com.
Πηγή: International journal of pediatric otorhinolaryngology [Int J Pediatr Otorhinolaryngol] 2026 Aug; Vol. 207, pp. 112924. Date of Electronic Publication: 2026 Jul 08.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 8003603 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8464 (Electronic) Linking ISSN: 01655876 NLM ISO Abbreviation: Int J Pediatr Otorhinolaryngol Subsets: MEDLINE
Imprint Name(s): Publication: Limerick : Elsevier Scientific Publishers
Original Publication: [Amsterdam] Elsevier/North-Holland.
Ιατρικοί όροι (MeSH): Hospital Costs*/statistics & numerical data , Orbital Cellulitis*/economics , Orbital Cellulitis*/diagnosis , Cellulitis*/economics , Cellulitis*/diagnosis , Orbital Diseases*/economics , Orbital Diseases*/diagnosis, C-Reactive Protein/analysis ; Hospitalization/economics ; Humans ; Retrospective Studies ; Female ; Male ; Child, Preschool ; Child ; Severity of Illness Index ; Adolescent
Περίληψη: Background: Periorbital infections in children encompass a clinical spectrum from preseptal cellulitis (PC) to orbital spectrum disease (OSD), with markedly different management requirements and outcomes. The economic consequences of this distinction remain poorly characterized.
Objectives: To identify independent predictors of orbital involvement in children presenting with periorbital infection, and to quantify the impact of disease severity on hospital costs across five expenditure categories.
Methods: This retrospective cohort study included 219 pediatric patients managed at a tertiary center between 2016 and 2022. Patients were classified as PC (n = 177) or OSD (n = 42) using the modified Chandler Classification. Clinical, laboratory, radiological, and detailed cost data were collected. Multivariable logistic regression was used to identify independent predictors of OSD and of high-cost hospitalization.
Results: OSD patients were significantly older (median 7.5 vs. 5.0 years, p < 0.001), presented more frequently with pain, fever, and presenting symptom count ≥3, and had higher rates of extensive sinus involvement (54.8% vs. 20.3%, p < 0.001). C-reactive protein (CRP) and neutrophil counts were markedly elevated in OSD, while lymphocyte counts were significantly lower (median 2.6 vs. 4.0 × 103/μL, p < 0.001). Four variables independently predicted OSD: presenting symptom count ≥3 (adjusted OR [aOR] 4.90), extensive sinus involvement (aOR 3.01), age (aOR 1.12 per year), and CRP (aOR 1.09 per 10 mg/L); model AUC was 0.825. Median total cost was 8.3-fold higher in OSD than PC (USD 140.3 vs. 16.9, p < 0.001). OSD, sinusitis, and elevated CRP independently predicted high-cost hospitalization.
Conclusions: Age, presenting symptom count, extensive sinus involvement, and CRP assessed during the initial diagnostic evaluation support early identification of children at risk for orbital involvement. Although lymphopenia was associated with orbital spectrum disease on univariate analysis, it was not retained as an independent predictor in the final multivariable model; its potential clinical utility should be considered exploratory and warrants further investigation in larger prospective studies. Orbital involvement is associated with substantially higher hospital costs, driven primarily by service and medication expenditures.
(Copyright © 2026 Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest None declared.
Contributed Indexing: Keywords: C-reactive protein; Hospital costs; Orbital cellulitis; Preseptal cellulitis; Risk factors; Sinusitis
Substance Nomenclature: 9007-41-4 (C-Reactive Protein)
Entry Date(s): Date Created: 20260709 Date Completed: 20260717 Latest Revision: 20260717
Update Code: 20260718
DOI: 10.1016/j.ijporl.2026.112924
PMID: 42424680
Βάση Δεδομένων: MEDLINE
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  Data: Preseptal cellulitis versus orbital spectrum disease in children: Early predictors and impact on hospital costs.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Demir+E%22&quot;&gt;Demir E&lt;/searchLink&gt;; Pediatric Health and Diseases Clinic of Goztepe Prof Dr. Suleyman Yalcin City Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: esmanur123@gmail.com.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Hatipoglu+N%22&quot;&gt;Hatipoglu N&lt;/searchLink&gt;; Pediatric Health and Diseases Clinic of Bakirkoy Dr Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: naydin9@mynet.com.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Sari+EE%22&quot;&gt;Sari EE&lt;/searchLink&gt;; Pediatric Health and Diseases Clinic of Bakirkoy Dr Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: drergulsari@gmail.com.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Hatipoglu+SS%22&quot;&gt;Hatipoglu SS&lt;/searchLink&gt;; Pediatric Health and Diseases Clinic of Bakirkoy Dr Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey. Electronic address: sahat55@gmail.com.
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  Data: &lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Hospital+Costs%22&quot;&gt;Hospital Costs*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Hospital+Costs+statistics+%26+numerical+data%22&quot;&gt;statistics &amp; numerical data&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis%22&quot;&gt;Orbital Cellulitis*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis+economics%22&quot;&gt;economics&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis%22&quot;&gt;Orbital Cellulitis*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Cellulitis+diagnosis%22&quot;&gt;diagnosis&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cellulitis%22&quot;&gt;Cellulitis*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cellulitis+economics%22&quot;&gt;economics&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cellulitis%22&quot;&gt;Cellulitis*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Cellulitis+diagnosis%22&quot;&gt;diagnosis&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Diseases%22&quot;&gt;Orbital Diseases*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Diseases+economics%22&quot;&gt;economics&lt;/searchLink&gt; &lt;br /&gt;&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Diseases%22&quot;&gt;Orbital Diseases*&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MM&quot; term=&quot;%22Orbital+Diseases+diagnosis%22&quot;&gt;diagnosis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22C-Reactive+Protein%22&quot;&gt;C-Reactive Protein&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22C-Reactive+Protein+analysis%22&quot;&gt;analysis&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Hospitalization%22&quot;&gt;Hospitalization&lt;/searchLink&gt;/&lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Hospitalization+economics%22&quot;&gt;economics&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Humans%22&quot;&gt;Humans&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Retrospective+Studies%22&quot;&gt;Retrospective Studies&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Female%22&quot;&gt;Female&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Male%22&quot;&gt;Male&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Child%2C+Preschool%22&quot;&gt;Child, Preschool&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Child%22&quot;&gt;Child&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Severity+of+Illness+Index%22&quot;&gt;Severity of Illness Index&lt;/searchLink&gt; ; &lt;searchLink fieldCode=&quot;MH&quot; term=&quot;%22Adolescent%22&quot;&gt;Adolescent&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Periorbital infections in children encompass a clinical spectrum from preseptal cellulitis (PC) to orbital spectrum disease (OSD), with markedly different management requirements and outcomes. The economic consequences of this distinction remain poorly characterized.&lt;br /&gt;Objectives: To identify independent predictors of orbital involvement in children presenting with periorbital infection, and to quantify the impact of disease severity on hospital costs across five expenditure categories.&lt;br /&gt;Methods: This retrospective cohort study included 219 pediatric patients managed at a tertiary center between 2016 and 2022. Patients were classified as PC (n = 177) or OSD (n = 42) using the modified Chandler Classification. Clinical, laboratory, radiological, and detailed cost data were collected. Multivariable logistic regression was used to identify independent predictors of OSD and of high-cost hospitalization.&lt;br /&gt;Results: OSD patients were significantly older (median 7.5 vs. 5.0 years, p &amp;lt; 0.001), presented more frequently with pain, fever, and presenting symptom count ≥3, and had higher rates of extensive sinus involvement (54.8% vs. 20.3%, p &amp;lt; 0.001). C-reactive protein (CRP) and neutrophil counts were markedly elevated in OSD, while lymphocyte counts were significantly lower (median 2.6 vs. 4.0 &#215; 10&lt;superscript&gt;3&lt;/superscript&gt;/μL, p &amp;lt; 0.001). Four variables independently predicted OSD: presenting symptom count ≥3 (adjusted OR [aOR] 4.90), extensive sinus involvement (aOR 3.01), age (aOR 1.12 per year), and CRP (aOR 1.09 per 10 mg/L); model AUC was 0.825. Median total cost was 8.3-fold higher in OSD than PC (USD 140.3 vs. 16.9, p &amp;lt; 0.001). OSD, sinusitis, and elevated CRP independently predicted high-cost hospitalization.&lt;br /&gt;Conclusions: Age, presenting symptom count, extensive sinus involvement, and CRP assessed during the initial diagnostic evaluation support early identification of children at risk for orbital involvement. Although lymphopenia was associated with orbital spectrum disease on univariate analysis, it was not retained as an independent predictor in the final multivariable model; its potential clinical utility should be considered exploratory and warrants further investigation in larger prospective studies. Orbital involvement is associated with substantially higher hospital costs, driven primarily by service and medication expenditures.&lt;br /&gt; (Copyright &#169; 2026 Elsevier B.V. All rights reserved.)
– Name: Abstract
  Label: Competing Interests
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  Data: Declaration of competing interest None declared.
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;C-reactive protein; Hospital costs; Orbital cellulitis; Preseptal cellulitis; Risk factors; Sinusitis
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        Value: 10.1016/j.ijporl.2026.112924
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      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: 112924
    Subjects:
      – SubjectFull: C-Reactive Protein analysis
        Type: general
      – SubjectFull: Hospitalization economics
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Retrospective Studies
        Type: general
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        Type: general
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        Type: general
      – SubjectFull: Child, Preschool
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      – SubjectFull: Severity of Illness Index
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      – SubjectFull: Adolescent
        Type: general
      – SubjectFull: Hospital Costs statistics & numerical data
        Type: general
      – SubjectFull: Orbital Cellulitis economics
        Type: general
      – SubjectFull: Orbital Cellulitis diagnosis
        Type: general
      – SubjectFull: Cellulitis economics
        Type: general
      – SubjectFull: Cellulitis diagnosis
        Type: general
      – SubjectFull: Orbital Diseases economics
        Type: general
      – SubjectFull: Orbital Diseases diagnosis
        Type: general
    Titles:
      – TitleFull: Preseptal cellulitis versus orbital spectrum disease in children: Early predictors and impact on hospital costs.
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              Text: 2026 Aug
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