{
  "abstract": "Objectives To evaluate the association between corticosteroid use and clinical outcomes in children hospitalised with severe orbital infections, and to describe practice patterns of systemic corticosteroid use.Design Multi-site observational cohort study using hospital data from 2009 to 2018.Setting Canadian children’s hospitals (7) and community hospitals (3).Patients Children 2 months and 18 years hospitalised with severe orbital infections.Interventions Systemic corticosteroids at any timeMain outcome measures Length of hospital stay and surgical intervention using time-to-event Cox proportional hazards multivariable regression models to account for potential differences in timing of corticosteroid use (early, ≤24 hours or late, >24 hours after admission), with adjustment for covariates.Results Of the 1479 hospitalised children, 876 (59.2%) were male and median age was 5.3 years (IQR 2.2 to 9.8). Of the 65 (4.4%) who received corticosteroids, over half (53.8%) received them early. Median length of stay was 75.9 hours (IQR 47.1 to 130.4) and 98 (6.6%) underwent surgical intervention. Corticosteroid use was associated with delayed discharge and prolonged hospitalisation, as reflected by a HR of 0.73 (95% CI 0.55 to 0.96) in adjusted analyses. However, systemic corticosteroids had no association with surgical intervention (HR 0.82, 95% CI 0.36 to 1.88).Conclusion In a large cohort of hospitalised children with severe orbital infections, corticosteroids were used infrequently, and when used, were not associated with improved clinical outcomes. Further high-quality trial evidence is needed to determine if routine corticosteroids are safe and effective.",
  "authors": [
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Clarelle L Gonsalves"
    },
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Cornelia Borkhoff"
    },
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Sanjay Mahant"
    },
    {
      "affiliations": [
        "CHU Sainte-Justine, Montreal, Quebec, Canada"
      ],
      "name": "Olivier Drouin"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada",
        "Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"
      ],
      "name": "Catherine Pound"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada",
        "Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"
      ],
      "name": "Julie Quet"
    },
    {
      "affiliations": [
        "Department of Paediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada"
      ],
      "name": "Gita Wahi"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Trillium Health Partners, Mississauga, Ontario, Canada"
      ],
      "name": "Ann Bayliss"
    },
    {
      "affiliations": [
        "Alberta Children’s Hospital, Calgary, Alberta, Canada"
      ],
      "name": "Gemma Vomiero"
    },
    {
      "affiliations": [
        "Stollery Children’s Hospital, Edmonton, Alberta, Canada"
      ],
      "name": "Jessica L Foulds"
    },
    {
      "affiliations": [
        "North York General Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Ronik Kanani"
    },
    {
      "affiliations": [
        "Lakeridge Health, Oshawa, Ontario, Canada"
      ],
      "name": "Mahmoud Sakran"
    },
    {
      "affiliations": [
        "Kingston Health Sciences Centre, Kingston, Ontario, Canada"
      ],
      "name": "Anupam Sehgal"
    },
    {
      "affiliations": [
        "Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada",
        "Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Eleanor Pullenayegum"
    },
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Elysa Widjaja"
    },
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Arun Reginald"
    },
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Nikolaus E Wolter"
    },
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada"
      ],
      "name": "Patricia C Parkin"
    },
    {
      "affiliations": [
        "The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Peter J Gill"
    },
    {
      "affiliations": [],
      "name": "on behalf of Periorbital and Orbital Cellulitis (POC) Multicentre Study Group and Canadian Paediatric Inpatient Research Network (PIRN)"
    }
  ],
  "title": "Association of systemic corticosteroids and clinical outcomes in children hospitalised with severe orbital infections",
  "uid": "921396a9-17d8-5bf4-be32-fce4808fcd11"
}