Preseptal Versus Orbital Cellulitis in Children: An Observational Study.

BACKGROUND: Preseptal and orbital cellulitis are two types of infection surrounding the orbital septum with very different potential outcomes. Our aim was to describe key differential features of both conditions, laying special emphasis on diagnostic and therapeutic tools. METHODS: A retrospective review of patients admitted to a tertiary hospital over a 15-year period (January 2004-October 2019) was conducted. We included 198 patients with preseptal and 45 with orbital cellulitis. Descriptive statistics were performed to examine the available information. RESULTS: Statistically significant differences were found between patients with preseptal and orbital cellulitis regarding age (3.9 ± 2.14 vs. 7.5 ± 4.24 years), presence of fever (51.5% vs. 82.2%), and preexisting sinusitis (2% vs. 77.8%) (all P < 0.001). Diplopia, ophthalmoplegia and proptosis were only present in orbital cellulitis (P < 0.001). Median values of C-reactive protein were significantly higher among children with orbital involvement [136.35 mg/L (IQR 74.08-168.98) vs. 17.85 (IQR 6.33-50.10), P < 0.0001]. A CRP>120 mg/L cut-off point for orbital cellulitis was obtained. Early CT scans were performed in 75.6% of suspected orbital cellulitis and helped detecting complications at an early stage. Abscesses were revealed in 70.6% of cases, especially medial subperiosteal abscesses (58.8%). All patients received intravenous antibiotics, whereas corticosteroids were preferred in patients with orbital implication (8.6% vs. 73.3%, P < 0.001). Only 26.7% of patients required additional surgery. CONCLUSIONS: Clinical presentation and CRP are extremely sensitive for differential diagnosis of preseptal and orbital cellulitis. Prompt initiation of intravenous antibiotics is mandatory and can prevent surgical procedures even in cases with incipient abscesses.

Impacto del desconfinamiento por la pandemia por COVID-19 sobre el patrón de traumatismos observados en un servicio de urgencias / Impact of deconfinement due to the COVID-19 pandemic on the trauma pattern observed in an emergency department

Introducción: después de 42 días de confinamiento decretado por la situación de pandemia mundial por la COVID-19, se permitió la salida de los domicilios a los menores de 14 años. El objetivo de este estudio fue analizar el impacto de este periodo de desconfinamiento en el perfil de accidentes traumatológicos en niños. Material y métodos: se llevó a cabo un estudio observacional retrospectivo de los menores de 16 años atendidos en Urgencias de un hospital terciario por traumatismo entre el 26 de abril de 2020 y el inicio de la desescalada en la Comunidad de Madrid el día 24 de mayo del mismo año. Se comparó el número de traumatismos, las fracturas, el mecanismo de acción y la localización, entre otros, con respecto al mismo periodo del año anterior. Resultados: se observó un aumento significativo en el porcentaje de fracturas respecto al año 2019 (41,9 frente al 11,3%; p <0,001). El porcentaje de accidentes secundarios a vehículos con ruedas (43,9 frente al 6,2%; p <0,001) fue significativamente superior durante 2020, siendo los asociados a bicicleta (35,4%) y patinete (32,2%) los más frecuentes. Conclusiones: durante el periodo de desconfinamiento, se ha producido un notable incremento de los accidentes provocados por vehículos con ruedas en la población infantil, aunque esta observación probablemente esté influida por las medidas organizativas específicas puestas en marcha en Madrid en el periodo de tiempo estudiado (AU)

Introduction: after 42 days of lockdojavascript:void(Set_Locked(0,'GRAVA REGISTRO/COMPLEMENTO.x'))wn imposed due to the global COVID-19 pandemic, children under 14 years were allowed to leave their homes. The aim of the study was to analyse the impact of the period following the lifting of confinement measures on traumatic injury trends in children.Material and methods: we carried out a retrospective and observational study in children aged less than 16 years that presented with traumatic injuries to the emergency department of a tertiary care hospital between April 26 and the start of the scaling down in the Community of Madrid on May 24. We compared the frequency of traumatic injuries and fractures, the mechanism and site of injury and other variables to those recorded in the same period the year before.Results: there was a significant increase in the proportion of fractures compared to 2019 (41.9 vs. 11.3%; p <0.001). The percentage of accidents related to wheeled vehicles was significantly higher in 2020 (43.9 vs. 6.2%; p <0.001), with these accidents most frequently involving bicycles (35.4%) and scooters (32.2%).Conclusions: in the period following the lockdown, there was a remarkable increase in accidents related to wheeled vehicles in the paediatric population, although this outcome was probably influenced by specific organizational measures implemented in Madrid in the period under study. (AU)