Abstract
ObjectiveTo identify reliable clinical, biological, and radiological markers predicting the failure of medical treatment in pediatric patients with acute ethmoidal rhinosinusitis (AERS) and subperiosteal abscess, facilitating informed decisions regarding the need for surgical intervention.DesignRetrospective multicenter cohort study.SettingPediatric otorhinolaryngology departments at a tertiary-care center and a public hospital in France, spanning from January 2014 to January 2024.ParticipantsChildren under 18 years diagnosed with Chandler stage III orbital complication of AERS, confirmed by computed tomography (CT).InterventionsInitial treatment with antibiotics, with surgical intervention as required based on clinical evaluation.Main Outcome MeasuresFactors associated with the need for surgical intervention, including demographic data, clinical examination, C-reactive protein (CRP) levels, leukocyte count, and CT evaluation.ResultsOut of 65 patients, 31 (48%) underwent surgery and 34 (52%) were treated with antibiotics alone. In multivariate analysis adjusted for age, the significant factors associated with surgical intervention included complete eyelid closure (odds ratio (OR) = 7.6; P < .001), ophthalmoplegia (OR = 14.2; P < .001), clinical exophthalmos (OR = 25.0; P < .001), CRP level >60 mg/L (OR = 6.9; P = .006), leukocyte count >15,600 g/L (OR = 7.7; P = .002), radiological exophthalmos (OR = 6.1; P = .001), retro-septal cellulitis (OR = 3.5; P = .02), posterior ethmoid opacification (OR = 6.1; P = .03), and abscess width >4 mm (OR = 8.2; P = .01).Conclusions and RelevanceMany patients can be managed medically. However, complete eyelid closure should prompt a CT scan. Exophthalmos, retro-septal cellulitis, or an abscess wider than 4 mm is an indication for surgical drainage. Ophthalmoplegia should be interpreted in context. CRP level >60 mg/L, a leukocyte count >15,600 g/L, and posterior ethmoid opacification should lead to close monitoring. These findings can aid in developing a clinico-bio-radiological score to guide treatment decisions, potentially improving patient outcomes by standardizing care protocols.